Purpose of Review

The purpose of this manuscript is to provide a comprehensive review of postdural puncture headache (PDPH) with a focus on epidemiology, pathophysiology, treatment, and prophylaxis.

Recent Findings

PDPH is an adverse iatrogenic complication of neuraxial anesthesia that occurs following inadvertent puncture of the dura after epidural or spinal anesthesia. The overall incidence of PDPH after neuraxial procedures varies from 6 to 36%. The occurrence of PDPH can lead to increased patient morbidity, delayed discharge, and increased readmission. PDPH is a self-limiting postural headache that most often will resolve within 1 week, without need for treatment. Various prophylactic measures have been studied; however, more studies have been recommended to be undertaken in order to establish a proven benefit.

Summary

For mild PDPH, conservative treatments are currently focused around bed rest, as well as oral caffeine. For moderate-to-severe PDPH, epidural blood patch (EBP) remains the most effective treatment; however, this invasive treatment is not without inherent risks. Further less invasive treatments have been explored such as epidural saline, dextran 40 mg solutions, hydration, caffeine, sphenopalatine ganglion blocks, greater occipital nerve blocks, and surgical closure of the gap; all have shown promise. Further studies are essential to prove efficacy as well as safety over the proven treatment of epidural blood patches. There is still limited evidence in literature about the understanding of PDPH and optimal treatment.

中文翻译：

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硬膜外穿刺头痛的治疗和管理的全面更新。

审查目的

本手稿的目的是对硬膜后穿刺性头痛（PDPH）进行全面的综述，重点是流行病学，病理生理学，治疗和预防。

最近的发现

PDPH是神经硬膜外麻醉的不良医源性并发症，发生于硬膜外或脊髓麻醉后硬膜硬膜穿刺。经神经外科手术后PDPH的总发生率在6％至36％之间。PDPH的发生可能导致患者发病率增加，出院延迟和再入院增加。PDPH是一种自限性姿势性头痛，多数情况下无需治疗即可在1周内缓解。已经研究了各种预防措施；但是，建议进行更多的研究以建立已证实的益处。

概要

对于轻度PDPH，保守治疗目前集中在卧床休息以及口服咖啡因。对于中度至重度PDPH，硬膜外补血片（EBP）仍然是最有效的治疗方法。然而，这种侵入性治疗并非没有固有风险。进一步研究了侵入性较小的治疗方法，例如硬膜外盐水，右旋糖酐40 mg溶液，水合作用，咖啡因，蝶ala神经节阻滞，枕后神经阻滞和手术闭合间隙。所有人都表现出了希望。进一步的研究对证明硬膜外血斑的疗效和安全性至关重要。关于PDPH的理解和最佳治疗的文献仍然很少。