Abstract
Purpose
Postdural puncture headache (PDPH) is an iatrogenic complication of neuraxial blockade. We systematically reviewed the literature on parturients to determine the frequency onset, and duration of PDPH.
Methods
Citations on PDPH in the obstetrical population were identified by computerized searches, citation review, and hand searches of abstracts and conference proceedings. Citations were included if they contained extractable data on frequency, onset, or duration of PDPH. Using meta-analysis, we calculated pooled estimates of the frequency of accidental durai puncture for epidural needles and pooled estimates of the frequencies of PDPH for epidural and spinal needles.
Results
Parturients have approximately a 1.5% [95% confidence interval (CI) 1.5% to 1.5%) risk of accidental durai puncture with epidural insertion. Of these, approximately half (52.1%; 95% CI, 51.4% to 52.8%) will result in PDPH. The risk of PDPH from spinal needles diminishes with small diameter, atraumatic needles, but is still appreciable (Whitacre 27-gauge needle 1.7%; 95% CI, 1.6% to 1.8%). PDPH occurs as early as one day and as late as seven days after durai puncture and lasts 12 hrto seven days.
Conclusion
PDPH is a common complication for parturients undergoing neuraxial blockade.
Résumé
Objectif
Les céphalées post-ponction durale (CPPD) sont une complication iatrogène du bloc neuraxial. Une revue systématique des publications sur les parturientes a permis de déterminer la fréquence, le délai d’installation et la durée des CPPD.
Méthode
Les citations sur les CPPD dans la population obstétricale ont été repérées par des recherches informatisées, la revue des références et des recherches manuelles de résumés et de comptes rendus de conférences. Les références retenues devaient comporter des données sur la fréquence, le délai d’installation et la durée des CPPD. Nous avons calculé, par méta-analyse, les estimations groupées de la fréquence de ponction durale accidentelle par aiguilles péridurales et celles de la fréquence de CPPD par aiguilles péridurales et rachidiennes.
Résultats
Chez les parturientes, le risque de subir une ponction durale accidentelle avec une aiguille péridurale est d’environ 1,5 % [intervalle de confiance de 95 % (IC) 1,5 % à 1,5 %]. Environ la moitié de ces ponctions (52,1 % ; IC de 95 %, 51,4 % à 52,8 %) va provoquer des CPPD. Le risque de CPPD avec les aiguilles rachidiennes diminue pour des aiguilles atraumatiques de petit diamètre, mais demeure appréciable (aiguille Whitacre 27 G 1,7 % ; IC de 95 %, 1,6% à 1,8 %). Les CPPD surviennent parfois aussi tôt qu’un jour, et aussi tard que sept jours, après la ponction durale et durent de 12 h à sept jours.
Conclusion
Les CPPD sont une complication courante chez les parturientes qui subissent un bloc neuraxial.
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This work was supported in part by the St. Joseph’s Hospital Anesthesiologists’ Research Fund (Hamilton, Ontario, Canada) to Dr. Choi and was completed in partial fulfillment of the requirements for a Masters of Science (Health Research Methodology) degree to Dr. Choi. Dr. Jadad is a National Health Research Scholar for Health Canada.
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Choi, P.T., Galinski, S.E., Takeuchi, L. et al. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anesth 50, 460–469 (2003). https://doi.org/10.1007/BF03021057
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DOI: https://doi.org/10.1007/BF03021057