Postdural puncture headache (PDPH): Onset, duration, severity, and associated symptoms: An analysis of 75 consecutive patients with PDPH

Acta Anaesthesiologica Scandinavica - Tập 39 Số 5 - Trang 605-612 - 1995
H Lybecker1, M Djernes2, J. F. Schmidt2
1Department of Anaesthesiology and Intensive Care, Odense University Hospital, Denmark
2Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense and Department of Anaesthesia, Esbjerg Central Hospital, Esbjerg, Denmark

Tóm tắt

Among 873 consecutive patients who had undergone a total of 1021 spinal anaesthesias involving puncture of the lumbar dura, 75 (7.35%) complained of Postdural Puncture headache. (PDPH). The severity of each patient's PDPH was categorized, on a scale from mild to severe, on the basis of the onset, duration, severity of the heActa ches, and the degree to which they were accompained by auditory and vestibular symptoms. In the patients who developed PDPH, 65% developed symptoms within 24 hours of the lumbar punctures and 92% developed symptoms within 48 hours.For the patients who recovered spontaneously the mean duration of the PDPHs was 5 days, with a range of 1–12 days. PDPH was characterized by headachches that were influenced by the patient's posture and the severity of PDPH was categorized as follows:Mild PDPH resulted in a slight restriction of their physical activity. These patients were not confined to bed and had no associated symptoms.Moderate PDPH forced the patient to stay in bed for part of the day, and resulted in restricted physical activity. Associated symptoms were not necessarily present.Severe PDPH Patients were bedridden for the entire day and made no attempt to raise their head or to stand. Associated symptoms were always present.Fortyfive of the PDPH patients (60%) recovered spontaneously. Of these, 8 patients (11%) were categorized as mild cases of PDPH, 14 (19%) as moderate, and 23 (30%) patients as severe cases of PDPH. Thirty of the PDPH patients (40%) were treated with an autologous epidural bloodpatch (AEBP). Of these, 27 patients (36%) were classified as severe and 3 patients (4%) as moderate PDPH.ASSOCIATED SYMPTOMS were present in all patients who had severe PDPH and in 86 percent of the patients who had moderate degrees of PDPH. Of all the patients with PDPH, 60% complained of nausea, 24% of vomiting, 43% of stiffness of the neck, 13% of ocular symptoms, and 12% of auditive symptoms. The headches in the PDPH patients were localized to the frontal region, bilaterally, in 25% of the cases, occipitally in 27% of the cases and in both regions in the remaining 45% of the patients.

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Tài liệu tham khảo

10.1007/BF02792160

10.1213/00000539-199004000-00008

Poukkula E., 1984, The problem of post‐spinal headache, Ann Chir Gynaec-ol, 73, 139

10.1213/00000539-197409000-00040

10.1016/S0140-6736(79)91744-6

10.1016/S0140-6736(81)90586-9

Andersen A. P. D., 1986, Postspinaler” Kopfschmerz. Ist die 24 stündige flache Bettruhe eine Prophylaxe, Reg Anaesth, 9, 15

10.1016/0002-9610(53)90597-2

10.1093/bja/60.2.195

Arner O., 1952, Complications following spinal anaesthesia. Their significance and a technique to reduce their incidence, Acta Chir Scand

Driessen A, 1980, Pro‐spektive Untersuchungen zum Pathomechanismus des postspinalen Kopfschmerzen an einem ausgcwählten Krankengut, Reg Anaesth, 3, 38

10.1001/jama.227.7.786

10.1001/jama.229.6.684

10.1097/00000542-197810000-00016

10.1097/00000542-199205000-00011

10.1097/00004311-198602440-00012

Guyton A., 1976, Textbook of medical physiology, 414

Adriani J., 1976, Labat's regional anaesthesia, 366

Hess J. H., 1991, Postdural puncture headache: a literature review, AANA J;, 59, 549

10.1007/BF03008458

10.1111/j.1399-6576.1986.tb02441.x

Collins J. V., 1976, Principles of anesthesiology, 690

10.1111/j.1365-2044.1987.tb05270.x

Loers F. J., 1977, Teil‐Parese des Nervus stato‐acusticus ‐ eine seltene Komplikation der Spinalanaesthesie, Anesthetist, 26, 202

10.3109/01050399109045965

Dreyer M, 1990, Passegere Mittel‐ und Tieftonschwerörigkeit nach Spinalanaesthesie, Reg Anaesth, 13, 138

10.1016/S0140-6736(83)90619-0

10.1001/jama.1956.02970070018005

10.1016/S0196-0709(83)80071-4

10.1213/00000539-199011000-00020

10.1097/00000542-196903000-00011

Thorsén G., 1947, Neurological complications after spinal anesthesia and results from 2493 follow‐up cases, Acta Chir Scand, 95, 1

10.1177/0310057X8301100102

10.1097/00000542-197905000-00015

10.1097/00000542-198001000-00038

Hill F. C., 1986, Post‐dural puncture cephalgia, AANA J;, 54, 144

Gielen M., 1989, Post dural puncture headache. (PDPH): A review, Reg Anesth, 14, 101

Kortum K, 1979, Morbidity following spinal anaesthesia, Reg Anaesth, 2, 5

10.1213/00000539-198103000-00006

10.3171/jns.1981.55.3.0467

10.1177/0310057X8701500318

Edelmen J. D., 1980, Subdural hematomas after lumbar dural puncture, Anesthesiology, 52, 166

10.1097/00000542-197910000-00012

10.1097/00000542-198155060-00014

10.1097/00000542-198403000-00026

10.1111/j.1399-6576.1981.tb01620.x

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Acta Anaesthesiologica Scandinavica

Tập 39 Số 5

605-612

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