Geburtshilfliche Anästhesie – Prophylaxe und Therapie des postpunktionellen Kopfschmerzes

Maren Kleine-Brüggeney; Peter Kranke; Ulrike M Stamer

doi:10.1055/s-0031-1284471

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Table of Contents

Anästhesiol Intensivmed Notfallmed Schmerzther 2011; 46(07/08): 516-524
DOI: 10.1055/s-0031-1284471

Fachwissen

A-Topthema: Geburtshilfliche Anästhesie

Geburtshilfliche Anästhesie – Prophylaxe und Therapie des postpunktionellen Kopfschmerzes

Prophylaxis and therapy of postdural puncture headache – a critical evaluation of treatment options

Maren Kleine-Brüggeney

,

Peter Kranke

,

Ulrike M Stamer

Abstract

Zusammenfassung

Seit der Entwicklung der rückenmarksnahen Anästhesie vor über 110 Jahren ist der postpunktionelle Kopfschmerz (PDPH) als Komplikation bekannt. Seitdem wurden zahlreiche prophylaktische und therapeutische Maßnahmen erprobt, deren Effektivität z.T. unklar bleibt. Aufgrund der relativ niedrigen PDPH-Prävalenz sind prospektive RCTs selten und die hohe Selbstheilungsrate erschwert eine adäquate Interpretation nicht kontrollierter Studien. Eine Prophylaxe des PDPH nach verifizierter Duraperforation kann nicht empfohlen werden. Bei manifestem PDPH stellen Nichtopioidanalgetika die erste Behandlungsstufe dar. Bei unzureichender Schmerzreduktion, anhaltender Symptomatik und hohem Leidensdruck ist der epidurale Blutpatch unter Beachtung der Kontraindikationen die effektivste Therapie. Positive Berichte gibt es zu Theoyphyllin, Sumatriptan und ACTH, ohne dass eine evidenzbasierte Therapieempfehlung gegeben werden kann. Ein in Abstimmung mit der geburtshilflichen Abteilung erarbeiteter Behandlungsalgorithmus ist ratsam.

Abstract

Since the first description of spinal and epidural anaesthesia, postdural puncture headache (PDPH) is a well known complication. Its prophylaxis and treatment has been studied and discussed for more than 100 years, but the evidence is still limited. Due to relatively low prevalence of PDPH, prospective RCTs are often missing, and the frequently self-limiting character of PDPH impedes an adequate interpretation of results from studies without a control group. Taking side effects and complications into account, a prophylactic treatment of PDPH cannot be recommended. In case of PDPH, non-opioid analgesics are the first choice treatment. The epidural blood patch remains the mainstay of severe PDPH therapy. Noninvasive therapies like theophylline, sumatriptan and ACTH can be an alternative. However, an evidence-based recommendation is lacking. The development of standard operating procedures for accidental dural punctures and PDPH is recommended.

Schlüsselwörter:

postpunktioneller Kopfschmerz - PDPH - Duraperforation - epiduraler Blutpatch

Keywords:

postdural puncture headache - PDPH - dural puncture - epidural blood patch

Full Text

References

Literatur
1 Costigan SN, Sprigge JS. Dural puncture: the patients' perspective. A patient survey of cases at a DGH maternity unit 1983-1993. Acta Anaesthesiol Scand 1996; 40: 710-714
2 Halpern S, Preston R. Postdural puncture headache and spinal needle design. Metaanalyses. Anesthesiology 1994; 81: 1376-1383
3 Riley ET, Cohen SE, Macario A, Desai JB, Ratner EF. Spinal versus epidural anesthesia for cesarean section: a comparison of time efficiency, costs, charges, and complications. Anesth Analg 1995; 80: 709-712
4 Stamer UM, Wiese R, Stuber F, Wulf H, Meuser T. Change in anaesthetic practice for Caesarean section in Germany. Acta Anaesthesiol Scand 2005; 49: 170-176
5 Bier A. Versuche über die Cocainisierung des Rückenmarks. Deutsche Zeitschrift für Chirurgie 1899; 51: 361-368
6 Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth 2003; 91: 718-729
7 Schwarz U, Schwan C, Strumpf M, Witscher K, Zenz M. Postdural puncture headache: diagnosis, prevention and therapy. Schmerz 1999; 13: 332-340
8 Grant R, Condon B, Hart I, Teasdale GM. Changes in intracranial CSF volume after lumbar puncture and their relationship to post-LP headache. J Neurol Neurosurg Psychiatry 1991; 54: 440-442
9 Gaiser R. Postdural puncture headache. Curr Opin Anaesthesiol 2006; 19: 249-253
10 Halker RB, Demaerschalk BM, Wellik KE et al. Caffeine for the prevention and treatment of postdural puncture headache: debunking the myth. Neurologist 2007; 13: 323-327
11 Internationale Klassifikation von Kopfschmerzerkrankungen. www.ihs-classification.org/de/02_klassifikation/03_teil2/07.02.01_nonvascular.html
12 Ahmed SV, Jayawarna C, Jude E. Post lumbar puncture headache: diagnosis and management. Postgrad Med J 2006; 82: 713-716
13 Kessler P, Wulf H. Duraperforation - postpunktioneller Kopfschmerz - Prophylaxe- und Therapiemöglichkeiten. Anasthesiol Intensivmed Notfallmed Schmerzther 2008; 43: 346-352
14 Volk T. Spinalanästhesie - Typische Komplikationen und wie man sie vermeiden kann. Anasthesiol Intensivmed Notfallmed Schmerzther 2010; 45: 188-195
15 Douglas MJ, Ward ME, Campbell DC, Bright SB, Merrick PM. Factors involved in the incidence of post-dural puncture headache with the 25 gauge Whitacre needle for obstetric anesthesia. Int J Obstet Anesth 1997; 6: 220-223
16 Klein AM, Loder E. Postpartum headache. Int J Obstet Anesth 2010; 19: 422-430
17 Edelman JD, Wingard DW. Subdural hematomas after lumbar dural puncture. Anesthesiology 1980; 52: 166-167
18 Newrick P, Read D. Subdural haematoma as a complication of spinal anaesthetic. Br Med J 1982; 285: 341-342
19 Schaffartzik W, Hachenberg T, Rust J, Neu J. Anästhesiezwischenfälle - Schäden durch Regionalanästhesie - ”closed claims“ der Norddeutschen Schlichtungsstelle. Anasthesiol Intensivmed Notfallmed Schmerzther 2011; 46: 40-46
20 Van de Velde M, Schepers R, Berends N, Vandermeersch E, De Buck F. Ten years of experience with accidental dural puncture and post-dural puncture headache in a tertiary obstetric anaesthesia department. Int J Obstet Anesth 2008; 17: 329-335
21 Paech M, Banks S, Gurrin L. An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients. Int J Obstet Anesth 2001; 10: 162-167
22 Sprigge JS, Harper SJ. Accidental dural puncture and post dural puncture headache in obstetric anaesthesia: presentation and management: a 23-year survey in a district general hospital. Anaesthesia 2008; 63: 36-43
23 Morley-Forster PK, Singh S, Angle P et al. The effect of epidural needle type on postdural puncture headache: a randomized trial. Can J Anaesth 2006; 53: 572-578
24 Thew M, Paech MJ. Management of postdural puncture headache in the obstetric patient. Curr Opin Anaesthesiol 2008; 21: 288-292
25 Chan TM, Ahmed E, Yentis SM, Holdcroft A. Postpartum headaches: summary report of the National Obstetric Anaesthetic Database (NOAD) 1999. Int J Obstet Anesth 2003; 12: 107-112
26 Stride PC, Cooper GM. Dural taps revisited. A 20-year survey from Birmingham Maternity Hospital. Anaesthesia 1993; 48: 247-255
27 Leach A, Smith GB. Subarachnoid spread of epidural local anaesthetic following dural puncture. Anaesthesia 1988; 43: 671-674
28 Hodgkinson R. Total spinal block after epidural injection into an interspace adjacent to an inadvertent dural perforation. Anesthesiology 1981; 55: 593-595
29 Baraz R, Collis RE. The management of accidental dural puncture during labour epidural analgesia: a survey of UK practice. Anaesthesia 2005; 60: 673-679
30 Morton CP, Swann DG. The management of accidental dural puncture in labour. Anaesthesia 1992; 47: 78-79
31 Rutter SV, Shields F, Broadbent CR, Popat M, Russell R. Management of accidental dural puncture in labour with intrathecal catheters: an analysis of 10 years' experience. Int J Obstet Anesth 2001; 10: 177-181
32 Marcus HE, Fabian A, Teschendorf P et al. Postpunktionskopfschmerz in der geburtshilflichen Anästhesie – Eine Umfrage zum Management in Deutschland. Deutscher Schmerzkongress 2010; 18: 17-17
33 Palmer CM. Continuous spinal anesthesia and analgesia in obstetrics. Anesth Analg 2010; 111: 1476-1479
34 Apfel CC, Saxena A, Cakmakkaya OS et al. Prevention of postdural puncture headache after accidental dural puncture: a quantitative systematic review. Br J Anaesth 2010; 105: 255-263
35 Denny N, Masters R, Pearson D et al. Postdural puncture headache after continuous spinal anesthesia. Anesth Analg 1987; 66: 791-794
36 Cohen S, Amar D, Pantuck EJ, Singer N, Divon M. Decreased incidence of headache after accidental dural puncture in caesarean delivery patients receiving continuous postoperative intrathecal analgesia. Acta Anaesthesiol Scand 1994; 38: 716-718
37 Ayad S, Demian Y, Narouze SN, Tetzlaff JE. Subarachnoid catheter placement after wet tap for analgesia in labor: influence on the risk of headache in obstetric patients. Reg Anesth Pain Med 2003; 28: 512-515
38 Kaul B, Sines D, Vallejo MC, Derenzo J, Waters J. A five year experience with post dural puncture headaches. Anesthesiology Abstract A 2007;
39 Norris MC, Leighton BL. Continuous spinal anesthesia after unintentional dural puncture in parturients. Reg Anesth 1990; 15: 285-287
40 Schwalbe S. Pathophysiology and Management of Post-dural Puncture Headache: A Current Review. SOAP Newsletter Fall www.soap.org/media/newsletters/fall2000/pathophysiology_management.htm 2000;
41 Carbaat PA, van Crevel H. Lumbar puncture headache: controlled study on the preventive effect of 24 hours' bed rest. Lancet 1981; 2: 1133-1135
42 Teece S, Crawford I. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Bed rest after lumbar puncture. Emerg Med J 2002; 19: 432-433
43 Spriggs DA, Burn DJ, French J, Cartlidge NE, Bates D. Is bed rest useful after diagnostic lumbar puncture?. Postgrad Med J 1992; 68: 581-583
44 Jones RJ. The role of recumbency in the prevention and treatment of postspinal headache. Anesth Analg 1974; 53: 788-796
45 Eldor J. Opiate treatment of post dural puncture headache. Acta Anaesthesiol Scand 1995; 39: 1140-1140
46 Saper JR, Lake 3rd. AE. Continuous opioid therapy (COT) is rarely advisable for refractory chronic daily headache: limited efficacy, risks, and proposed guidelines. Headache 2008; 48: 838-849
47 Holder H. Reactions after spinal anesthesia. JAMA 1944; 124: 56-57
48 Camann WR, Murray RS, Mushlin PS, Lambert DH. Effects of oral caffeine on postdural puncture headache. A double-blind, placebo-controlled trial. Anesth Analg 1990; 70: 181-184
49 Yucel A, Ozyalcin S, Talu GK, Yucel EC, Erdine S. Intravenous administration of caffeine sodium benzoate for postdural puncture headache. Reg Anesth Pain Med 1999; 24: 51-54
50 Esmaoglu A, Akpinar H, Ugur F. Oral multidose caffeine-paracetamol combination is not effective for the prophylaxis of postdural puncture headache. J Clin Anesth 2005; 17: 58-61
51 Jarvis AP, Greenawalt JW, Fagraeus L. Intravenous caffeine for postdural puncture headache. Anesth Analg 1986; 65: 316-317
52 Sechzer PH, Abel L. Post-spinal headache treated with caffeine. Evaluation with demand method. Part I. Current Therapeutic Research 1978; 24: 307-312
53 Stiftung Warentest. www.test.de/themen/essen-trinken/meldung/Koffeinhaltige-Getraenke-Wenn-das-Herz-schneller-schlaegt-1117094–1117137/
54 Rice I, Radhakrishnan D, Nelson-Piercy C. Cerebral vasoconstrictors and postdural puncture headache: the big squeeze. Br J Anaesth 2003; 90: 527-527
55 Oliver CD, White SA. Unexplained fitting in three parturients suffering from postdural puncture headache. Br J Anaesth 2002; 89: 782-785
56 Cohen SM, Laurito CE, Curran MJ. Grand mal seizure in a postpartum patient following intravenous infusion of caffeine sodium benzoate to treat persistent headache. J Clin Anesth 1992; 4: 48-51
57 Bolton VE, Leicht CH, Scanlon TS. Postpartum seizure after epidural blood patch and intravenous caffeine sodium benzoate. Anesthesiology 1989; 70: 146-149
58 Ergun U, Say B, Ozer G et al. Intravenous theophylline decreases post-dural puncture headaches. J Clin Neurosci 2008; 15: 1102-1104
59 Ibayashi S, Ngai AC, Meno JR, Winn HR. The effects of dipyridamole and theophylline on rat pial vessels during hypocarbia. J Cereb Blood Flow Metab 1988; 8: 829-833
60 Choi A, Laurito CE, Cunningham FE. Pharmacologic management of postdural puncture headache. Ann Pharmacother 1996; 30: 831-839
61 Feuerstein TJ, Zeides A. Theophylline relieves headache following lumbar puncture. Placebo-controlled, double-blind pilot study. Klin Wochenschr 1986; 64: 216-218
62 Schwalbe SS, Schiffmiller MW, Marx GF. Theophylline for post-dural puncture headache. Anesthesiology. Abstract 1991;
63 Francis GJ, Becker WJ, Pringsheim TM. Acute and preventive pharmacologic treatment of cluster headache. Neurology 2010; 75: 463-473
64 Hodgson C, Roitberg-Henry A. The use of sumatriptan in the treatment of postdural puncture headache. Anaesthesia 1997; 52: 808-808
65 Sprigge JS. The use of sumatriptan in the treatment of postdural puncture headache after accidental lumbar puncture complicated a blood patch procedure. Anaesthesia 1999; 54: 95-96
66 Carp H, Singh PJ, Vadhera R, Jayaram A. Effects of the serotonin-receptor agonist sumatriptan on postdural puncture headache: report of six cases. Anesth Analg 1994; 79: 180-182
67 Lhuissier C, Mercier FJ, Dounas M, Benhamou D. Sumatriptan: an alternative to epidural blood patch?. Anaesthesia 1996; 51: 1078-1078
68 Connelly NR, Parker RK, Rahimi A, Gibson CS. Sumatriptan in patients with postdural puncture headache. Headache 2000; 40: 316-319
69 Bussone G, Tullo V, d'Onofrio F et al. Frovatriptan for the prevention of postdural puncture headache. Cephalalgia 2007; 27: 809-813
70 Hutter CD. Sumatriptan and postdural puncture headache. Anaesthesia 1997; 52: 1119-1119
71 Carter BL, Pasupuleti R. Use of intravenous cosyntropin in the treatment of postdural puncture headache. Anesthesiology 2000; 92: 272-274
72 Gupta S, Agrawal A. Postdural puncture headache and ACTH. J Clin Anesth 1997; 9: 258-258
73 Kshatri AM, Foster PA. Adrenocorticotropic hormone infusion as a novel treatment for postdural puncture headache. Reg Anesth 1997; 22: 432-434
74 Canovas L, Barros C, Gomez A, Castro M, Castro A. Use of intravenous tetracosactin in the treatment of postdural puncture headache: our experience in forty cases. Anesth Analg 2002; 94: 1369-1369
75 Ghai A, Wadhera R. Adrenocorticotrophic hormone – is a single dose sufficient for post-dural puncture headache?. Acta Anaesthesiol Scand 2007; 51: 266-266
76 Foster P. ACTH treatment for post-lumbar puncture headache. Br J Anaesth 1994; 73: 429-429
77 Collier BB. Treatment for post dural puncture headache. Br J Anaesth 1994; 72: 366-367
78 Hakim SM. Cosyntropin for prophylaxis against postdural puncture headache after accidental dural puncture. Anesthesiology 2010; 113: 413-420
79 Rucklidge MW, Yentis SM, Paech MJ. Synacthen Depot for the treatment of postdural puncture headache. Anaesthesia 2004; 59: 138-141
80 Lin YT, Sheen MJ, Huang ST et al. Gabapentin relieves post-dural puncture headache – a report of two cases. Acta Anaesthesiol Taiwan 2007; 45: 47-51
81 Zencirci B. Postdural puncture headache and pregabalin. J Pain Res 2010; 3: 11-14
82 Sheen MJ, Ho ST. Mirtazapine relieves postdural puncture headache. Anesth Analg 2008; 107: 346-346
83 Massou S, Drissi M, Hatim G et al. Does propofol have effect on postdural puncture headache?. Ann Fr Anesth Reanim 2008; 27: 861-862
84 Al-metwalli RR. Epidural morphine injections for prevention of post dural puncture headache. Anaesthesia 2008; 63: 847-850
85 Abboud TK, Zhu J, Reyes A et al. Effect of subarachnoid morphine on the incidence of spinal headache. Reg Anesth 1992; 17: 34-36
86 Usubiaga JE, Usubiaga LE, Brea LM, Goyena R. Effect of saline injections on epidural and subarachnoid space pressures and relation to postspinal anesthesia headache. Anesth Analg 1967; 46: 293-296
87 Bart AJ, Wheeler AS. Comparison of epidural saline placement and epidural blood placement in the treatment of post-lumbar-puncture headache. Anesthesiology 1978; 48: 221-223
88 Trivedi NS, Eddi D, Shevde K. Headache prevention following accidental dural puncture in obstetric patients. J Clin Anesth 1993; 5: 42-45
89 Charsley MM, Abram SE. The injection of intrathecal normal saline reduces the severity of postdural puncture headache. Reg Anesth Pain Med 2001; 26: 301-305
90 Craft JB, Epstein BS, Coakley CS. Prophylaxis of dural-puncture headache with epidural saline. Anesth Analg 1973; 52: 228-231
91 Brownridge P. The management of headache following accidental dural puncture in obstetric patients. Anaesth Intensive Care 1983; 11: 4-15
92 Warwick WI, Neal JM. Beyond spinal headache: prophylaxis and treatment of low-pressure headache syndromes. Reg Anesth Pain Med 2007; 32: 455-461
93 Barrios-Alarcon J, Aldrete JA, Paragas-Tapia D. Relief of post-lumbar puncture headache with epidural dextran 40: a preliminary report. Reg Anesth 1989; 14: 78-80
94 Salvador L, Carrero E, Castillo J, Villalonga A, Nalda MA. Prevention of post dural puncture headache with epidural-administered dextran 40. Reg Anesth 1992; 17: 357-358
95 Boonmak P, Boonmak S. Epidural blood patching for preventing and treating post-dural puncture headache. Cochrane Database of Systematic Reviews Art. No.: CD001791. 2010;
96 Scavone BM, Wong CA, Sullivan JT et al. Efficacy of a prophylactic epidural blood patch in preventing post dural puncture headache in parturients after inadvertent dural puncture. Anesthesiology 2004; 101: 1422-1427
97 Harrington H, Tyler HR, Welch K. Surgical treatment of post-lumbar puncture dural CSF leak causing chronic headache. Case report. J Neurosurg 1982; 57: 703-707
98 Chan BO, Paech MJ. Persistent cerebrospinal fluid leak: a complication of the combined spinal-epidural technique. Anesth Analg table of contents 2004; 98
99 Lennon M, Seigne P, Cunningham AJ. Pituitary apoplexy after spinal anaesthesia. Br J Anaesth 1998; 81: 616-618
Eggert SM, Eggers KA. Subarachnoid haemorrhage following spinal anaesthesia in an obstetric patient. Br J Anaesth 2001; 86: 442-444
Whiteley SM, Murphy PG, Kirollos RW, Swindells SR. Headache after dural puncture. BMJ 1993; 306: 917-918
Zeidan A, Farhat O, Maaliki H, Baraka A. Does postdural puncture headache left untreated lead to subdural hematoma? Case report and review of the literature. Int J Obstet Anesth 2006; 15: 50-58
Gaucher Jr. DJ, Perez Jr. JA. Subdural hematoma following lumbar puncture. Arch Intern Med 2002; 162: 1904-1905
Diemunsch P, Balabaud VP, Petiau C et al. Bilateral subdural hematoma following epidural anesthesia. Can J Anaesth 1998; 45: 328-331
Pavlin DJ, McDonald JS, Child B, Rusch V. Acute subdural hematoma--an unusual sequela to lumbar puncture. Anesthesiology 1979; 51: 338-340
Stocks GM, Wooller DJ, Young JM, Fernando R. Postpartum headache after epidural blood patch: investigation and diagnosis. Br J Anaesth 2000; 84: 407-410
Wilder-Smith E, Kothbauer-Margreiter I, Lammle B et al. Dural puncture and activated protein C resistance: risk factors for cerebral venous sinus thrombosis. J Neurol Neurosurg Psychiatry 1997; 63: 351-356
Lockhart EM, Baysinger CL. Intracranial venous thrombosis in the parturient. Anesthesiology 2007; 107: 652-658
Borum SE, Naul LG, McLeskey CH. Postpartum dural venous sinus thrombosis after postdural puncture headache and epidural blood patch. Anesthesiology 1997; 86: 487-490
Reynolds F. Dural puncture and headache. Regional analgesia in obstetrics. A millenium update. London: Springer; 2000: 307-320
Nurboja B, Rezajooi K, Newton MC, Casey AT. Spinal meningocele due to iatrogenic dural puncture during epidural analgesia for childbirth: 5-year history of headache with a spinal etiology. J Neurosurg Spine 2009; 11: 764-767
Roberts SP, Petts HV. Meningitis after obstetric spinal anaesthesia. Anaesthesia 1990; 45: 376-377
Baer ET. Post-dural puncture bacterial meningitis. Anesthesiology 2006; 105: 381-393
Pandian JD, Sarada C, Radhakrishnan VV, Kishore A. Iatrogenic meningitis after lumbar puncture-a preventable health hazard. J Hosp Infect 2004; 56: 119-124
Kuczkowski KM. The potential dangers of caffeine in pregnancy. Acta Anaesthesiol Scand 2010; 54: 524-525
Dutton DA. A 'postspinal headache' associated with incidental intracranial pathology. Anaesthesia 1991; 46: 1044-1046
Alfery DD, Marsh ML, Shapiro HM. Post-spinal headache or intracranial tumor after obstetric anesthesia. Anesthesiology 1979; 51: 92-94
Eede HV, Hoffmann VL, Vercauteren MP. Post-delivery postural headache: not always a classical post-dural puncture headache. Acta Anaesthesiol Scand 2007; 51: 763-765

Supplementary Material

Literature