nach oben

Erschienen in:

14.07.2022 | Periduralanästhesie | CME

Postpunktionskopfschmerz in der Geburtshilfe

Pathogenese, Diagnostik und Therapie

verfasst von: Dr. med. Benedikt Hermann Siegler, Dr. med. Beatrice Oehler, Prof. Dr. med. Peter Kranke, Prof. Dr. med. Markus Alexander Weigand

Erschienen in: Die Anaesthesiologie | Ausgabe 8/2022

Einloggen, um Zugang zu erhalten

Zusammenfassung

Der Postpunktionskopfschmerz („postdural puncture headache“, PDPH) zählt zu den wesentlichen Komplikationen der peripartalen neuroaxialen Analgesie. Als ursächlich gelten der Verlust von Liquorvolumen und -druck sowie die kompensatorisch auftretende intrakranielle Vasodilatation. Potenziell schwerwiegende Langzeitfolgen erfordern die korrekte PDPH-Diagnose, den Ausschluss relevanter Differenzialdiagnosen (ggf. mithilfe bildgebender Verfahren) und die rasche Einleitung einer effektiven Therapie. Nichtopioidanalgetika, Koffein sowie ggf. Theophyllin, Gabapentin und Hydrokortison bilden therapeutische Grundpfeiler; bei persistierenden Beschwerden ist die zeitnahe Anlage eines epiduralen Blut-Patch (EBP) der Goldstandard. Verfahren der Neuraltherapie stellen vielversprechende Alternativen dar, insbesondere wenn ein EBP nicht erwünscht oder kontraindiziert ist. Ein interdisziplinär und interprofessionell abgesprochenes Standardvorgehen kann zur Optimierung des klinischen Managements dieser relevanten Komplikation beitragen.

Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA (2005) Obstetric anesthesia workforce survey: twenty-year update. Anesthesiology 103:645–653PubMedCrossRef

Brebion M, Bonnet MP, Sauvegrain P, Saurel-Cubizolles MJ, Blondel B et al (2021) Use of labour neuraxial analgesia according to maternal immigration status: a national cross-sectional retrospective population-based study in France. Br J Anaesth 127:942–952PubMedCrossRef

Seijmonsbergen-Schermers AE, van den Akker T, Rydahl E (2020) Variations in use of childbirth interventions in 13 high-income countries: a multinational cross-sectional study. PLoS Med 17:e1003103PubMedPubMedCentralCrossRef

Butwick AJ, Bentley J, Wong CA, Snowden JM, Sun E et al (2018) United States state-level variation in the use of neuraxial analgesia during labor for pregnant women. JAMA Netw Open 1:e186567PubMedPubMedCentralCrossRef

Delgado C, Bollag L, Van Cleve W (2020) Neuraxial labor analgesia utilization, incidence of postdural puncture headache, and epidural blood patch placement for privately insured parturients in the United States (2008–2015). Anesth Analg 131:850–856PubMedCrossRef

Orbach-Zinger S, Ashwal E, Hazan L, Bracco D, Ioscovich A et al (2016) Risk factors for unintended dural puncture in obstetric patients: a retrospective cohort study. Anesth Analg 123:972–976PubMedCrossRef

Singh S, Chaudry SY, Phelps AL, Vallejo MC (2009) A 5‑year audit of accidental dural punctures, postdural puncture headaches, and failed regional anesthetics at a tertiary-care medical center. ScientificWorldJournal 9:715–722PubMedPubMedCentralCrossRef

D’Angelo R, Smiley RM, Riley ET, Segal S (2014) Serious complications related to obstetric anesthesia: the serious complication repository project of the society for obstetric anesthesia and perinatology. Anesthesiology 120:1505–1512PubMedCrossRef

Guglielminotti J, Landau R, Li G (2019) Major neurologic complications associated with postdural puncture headache in obstetrics: a retrospective cohort study. Anesth Analg 129:1328–1336PubMedCrossRef

10.

Ansari JR, Barad M, Shafer S, Flood P (2021) Chronic disabling postpartum headache after unintentional dural puncture during epidural anaesthesia: a prospective cohort study. Br J Anaesth 127:600–607PubMedCrossRef

11.

Barad M, Carroll I, Reina MA, Ansari J, Flood P (2021) Did she have an epidural? The long-term consequences of postdural puncture headache and the role of unintended dural puncture. Headache 61:1314–1323PubMedCrossRef

12.

Mims SC, Tan HS, Sun K, Pham T, Rubright S et al (2022) Long-term morbidities following unintentional dural puncture in obstetric patients: a systematic review and meta-analysis. J Clin Anesth 79:110787PubMedCrossRef

13.

Ranganathan P, Golfeiz C, Phelps AL, Singh S, Shnol H et al (2015) Chronic headache and backache are long-term sequelae of unintentional dural puncture in the obstetric population. J Clin Anesth 27:201–206PubMedCrossRef

14.

Costigan SN, Sprigge JS (1996) Dural puncture: the patients’ perspective. A patient survey of cases at a DGH maternity unit 1983–1993. Acta Anaesthesiol Scand 40:710–714PubMedCrossRef

15.

Sakka L, Coll G, Chazal J (2011) Anatomy and physiology of cerebrospinal fluid. Eur Ann Otorhinolaryngol Head Neck Dis 128:309–316PubMedCrossRef

16.

Mokri B, Atkinson JL, Piepgras DG (2000) Absent headache despite CSF volume depletion (intracranial hypotension). Neurology 55:1722–1724PubMedCrossRef

17.

Frank RL (2008) Lumbar puncture and post-dural puncture headaches: implications for the emergency physician. J Emerg Med 35:149–157PubMedCrossRef

18.

Trefler A, Sadeghi N, Thomas AG, Pierpaoli C, Baker CI et al (2016) Impact of time-of-day on brain morphometric measures derived from T1-weighted magnetic resonance imaging. Neuroimage 133:41–52PubMedCrossRef

19.

Yokoyama Y, Yamada Y, Kosugi K, Yamada M, Narita K et al (2021) Effect of gravity on brain structure as indicated on upright computed tomography. Sci Rep 11:392PubMedPubMedCentralCrossRef

20.

Grant R, Condon B, Hart I, Teasdale GM (1991) Changes in intracranial CSF volume after lumbar puncture and their relationship to post-LP headache. J Neurol Neurosurg Psychiatry 54:440–442PubMedPubMedCentralCrossRef

21.

Bezov D, Ashina S, Lipton R (2010) Post-dural puncture headache: part II—prevention, management, and prognosis. Headache 50:1482–1498PubMedCrossRef

22.

Bezov D, Lipton RB, Ashina S (2010) Post-dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiology. Headache 50:1144–1152PubMedCrossRef

23.

Wu CL, Rowlingson AJ, Cohen SR, Michaels RK, Courpas GE et al (2006) Gender and post-dural puncture headache. Anesthesiology 105:613–618PubMedCrossRef

24.

Vandam LD, Dripps RD (1956) Long-term follow-up of patients who received 10,098 spinal anesthetics; syndrome of decreased intracranial pressure (headache and ocular and auditory difficulties). J Am Med Assoc 161:586–591PubMedCrossRef

25.

Lybecker H, Møller JT, May O, Nielsen HK (1990) Incidence and prediction of postdural puncture headache. A prospective study of 1021 spinal anesthesias. Anesth Analg 70:389–394PubMedCrossRef

26.

DelPizzo K, Luu T, Fields KG, Sideris A, Dong N et al (2020) Risk of postdural puncture headache in adolescents and adults. Anesth Analg 131:273–279PubMedPubMedCentralCrossRef

27.

Peralta F, Higgins N, Lange E, Wong CA, McCarthy RJ (2015) The relationship of body mass index with the incidence of postdural puncture headache in parturients. Anesth Analg 121:451–456PubMedCrossRef

28.

Franz AM, Jia SY, Bahnson HT, Goel A, Habib AS (2017) The effect of second-stage pushing and body mass index on postdural puncture headache. J Clin Anesth 37:77–81PubMedCrossRef

29.

Amorim JA, Valença MM (2008) Postdural puncture headache is a risk factor for new postdural puncture headache. Cephalalgia 28:5–8PubMedCrossRef

30.

Angle P, Thompson D, Halpern S, Wilson DB (1999) Second stage pushing correlates with headache after unintentional dural puncture in parturients. Can J Anaesth 46:861–866PubMedCrossRef

31.

Costa AC, Satalich JR, Al-Bizri E, Shodhan S, Romeiser JL et al (2019) A ten-year retrospective study of post-dural puncture headache in 32,655 obstetric patients. Can J Anaesth 66:1464–1471PubMedCrossRef

32.

Dodge HS, Ekhator NN, Jefferson-Wilson L, Fischer M, Jansen I et al (2013) Cigarette smokers have reduced risk for post-dural puncture headache. Pain Phys 16:E25–30

33.

Ready LB, Cuplin S, Haschke RH, Nessly M (1989) Spinal needle determinants of rate of transdural fluid leak. Anesth Analg 69:457–460PubMedCrossRef

34.

Cruickshank RH, Hopkinson JM (1989) Fluid flow through dural puncture sites. An in vitro comparison of needle point types. Anaesthesia 44:415–418PubMedCrossRef

35.

Zhang D, Chen L, Chen X, Wang X, Li Y et al (2016) Lower incidence of postdural puncture headache using whitacre spinal needles after spinal anesthesia: a meta-analysis. Headache 56:501–510PubMedCrossRef

36.

Arevalo-Rodriguez I, Muñoz L, Godoy-Casasbuenas N, Ciapponi A, Arevalo JJ et al (2017) Needle gauge and tip designs for preventing post-dural puncture headache (PDPH). Cochrane Database Syst Rev 4:Cd10807PubMed

37.

Lee SI, Sandhu S, Djulbegovic B, Mhaskar RS (2018) Impact of spinal needle type on postdural puncture headache among women undergoing cesarean section surgery under spinal anesthesia: a meta-analysis. J Evid Based Med 11:136–144PubMedCrossRef

38.

Bremerich D, Annecke T, Chapell D, Hanß R, Kaufner L et al (2020) Die geburtshilfliche Analgesie und Anästhesie. S1-Leitlinie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin in Zusammenarbeit mit der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (registry number 001-038)

39.

Fresenius M, Heck M, Busch C (2017) Regionalanästhesie. In: Heck M, Fresenius M, Busch C (Hrsg) Repetitorium Anästhesiologie: Für die Facharztprüfung und das Europäische Diplom. Springer, Berlin, Heidelberg, S 373–416CrossRef

40.

Strupp M, Brandt T, Müller A (1998) Incidence of post-lumbar puncture syndrome reduced by reinserting the stylet: a randomized prospective study of 600 patients. J Neurol 245:589–592PubMedCrossRef

41.

Salzer J, Granåsen G, Sundström P, Vågberg M, Svenningsson A (2020) Prevention of post-dural puncture headache: a randomized controlled trial. Eur J Neurol 27:871–877PubMedCrossRef

42.

Haller G, Cornet J, Boldi MO, Myers C, Savoldelli G et al (2018) Risk factors for post-dural puncture headache following injury of the dural membrane: a root-cause analysis and nested case-control study. Int J Obstet Anesth 36:17–27PubMedCrossRef

43.

Seeberger MD, Kaufmann M, Staender S, Schneider M, Scheidegger D (1996) Repeated dural punctures increase the incidence of postdural puncture headache. Anesth Analg 82:302–305PubMed

44.

Weinrich J, von Heymann C, Henkelmann A, Balzer F, Obbarius A et al (2020) Postdural puncture headache after neuraxial anesthesia: incidence and risk factors. Anaesthesist 69:878–885PubMedPubMedCentralCrossRef

45.

Orbach-Zinger S, Heesen M, Ioscovich A, Shatalin D, Aptekman B et al (2022) Anesthesiologists’ perspectives on why dural punctures occur: a multicenter international survey. Reg Anesth Pain Med 47:249–250PubMedCrossRef

46.

Headache Classification Committee of the International Headache Society (2018) The international classification of headache disorders, 3rd edition. Cephalalgia 38:1–211

47.

Turnbull DK, Shepherd DB (2003) Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth 91:718–729PubMedCrossRef

48.

Lybecker H, Djernes M, Schmidt JF (1995) Postdural puncture headache (PDPH): onset, duration, severity, and associated symptoms. An analysis of 75 consecutive patients with PDPH. Acta Anaesthesiol Scand 39:605–612PubMedCrossRef

49.

Russell R, Laxton C, Lucas DN, Niewiarowski J, Scrutton M et al (2019) Treatment of obstetric post-dural puncture headache. Part 2: epidural blood patch. Int J Obstet Anesth 38:104–118PubMedCrossRef

50.

Loures V, Savoldelli G, Kern K, Haller G (2014) Atypical headache following dural puncture in obstetrics. Int J Obstet Anesth 23:246–252PubMedCrossRef

51.

Amorim JA, Gomes de Barros MV, Valença MM (2012) Post-dural (post-lumbar) puncture headache: risk factors and clinical features. Cephalalgia 32:916–923PubMedCrossRef

52.

Anzola GP, Brighenti R, Cobelli M, Giossi A, Mazzucco S et al (2017) Postpartum headache: a prospective study. J Oral Facial Pain Headache 31:346–352PubMedCrossRef

53.

Goldszmidt E, Kern R, Chaput A, Macarthur A (2005) The incidence and etiology of postpartum headaches: a prospective cohort study. Can J Anaesth 52:971–977PubMedCrossRef

54.

Dieterich M (2018) Diagnostik und Therapie des postpunktionellen und spontanen Liquorunterdruck-Syndroms, S1-Guideline. www.dgn.org/leitlinien. Zugegriffen: 3. Apr. 2022

55.

Woodward WM, Levy DM, Dixon AM (1994) Exacerbation of post-dural puncture headache after epidural blood patch. Can J Anaesth 41:628–631PubMedCrossRef

56.

Stella CL, Jodicke CD, How HY, Harkness UF, Sibai BM (2007) Postpartum headache: is your work-up complete? Am J Obstet Gynecol 196:318.e1–318.e7CrossRef

57.

Orbach-Zinger S, Jadon A, Lucas DN, Sia AT, Tsen LC et al (2021) Intrathecal catheter use after accidental dural puncture in obstetric patients: literature review and clinical management recommendations. Anaesthesia 76:1111–1121PubMedCrossRef

58.

Deng J, Wang L, Zhang Y, Chang X, Ma X (2017) Insertion of an intrathecal catheter in parturients reduces the risk of post-dural puncture headache: a retrospective study and meta. Analysis 12:e180504

59.

Heesen M, Hilber N, Rijs K, van der Marel C, Rossaint R et al (2020) Intrathecal catheterisation after observed accidental dural puncture in labouring women: update of a meta-analysis and a trial-sequential analysis. Int J Obstet Anesth 41:71–82PubMedCrossRef

60.

Wu L, Chen S, Jiang X, Cheng Y, Zhang W (2021) Opioids for the prevention of post-dural puncture headache in obstetrics: a systematic review and meta-analysis of efficacy and safety. Pain Physician 24:E1155–e1162PubMed

61.

Cohen S, Stricker P, Sakr A (2005) Cerebrospinal fluid leak after disconnection of an intrathecal catheter adapter placed after accidental dural puncture. Reg Anesth Pain Med 30:591PubMedCrossRef

62.

Lenart MJ, Carness JM (2016) Cerebrospinal fluid-cutaneous fistula after continuous spinal catheter in an obstetric patient. A A Case Rep 7:103–107PubMedCrossRef

63.

Kamm K, Förderreuther S (2021) Post-dural puncture headache. Schmerz 35:139–149PubMedCrossRef

64.

Radke K, Radke OC (2013) Post-dural puncture headache. Anaesthesist 62:149–161PubMedCrossRef

65.

Arevalo-Rodriguez I, Ciapponi A, Roqué i Figuls M, Muñoz L, Bonfill Cosp X (2016) Posture and fluids for preventing post-dural puncture headache. Cochrane Database Syst Rev 3:Cd9199PubMed

66.

Basurto Ona X, Osorio D, Bonfill Cosp X (2015) Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev 2015:Cd7887PubMedCentral

67.

Baratloo A, Rouhipour A, Forouzanfar MM, Safari S, Amiri M et al (2016) The role of caffeine in pain management: a brief literature review. Anesth Pain Med 6:e33193PubMedPubMedCentralCrossRef

68.

Sills GJ (2006) The mechanisms of action of gabapentin and pregabalin. Curr Opin Pharmacol 6:108–113PubMedCrossRef

69.

Gupta A, von Heymann C, Magnuson A, Alahuhta S, Fernando R et al (2020) Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study. Br J Anaesth 125:1045–1055PubMedCrossRef

70.

Szeinfeld M, Ihmeidan IH, Moser MM, Machado R, Klose KJ et al (1986) Epidural blood patch: evaluation of the volume and spread of blood injected into the epidural space. Anesthesiology 64:820–822PubMedCrossRef

71.

Beards SC, Jackson A, Griffiths AG, Horsman EL (1993) Magnetic resonance imaging of extradural blood patches: appearances from 30 min to 18 h. Br J Anaesth 71:182–188PubMedCrossRef

72.

Shin HY (2022) Recent update on epidural blood patch. Anesth Pain Med 17:12–23CrossRef

73.

Carrie LE (1991) Epidural blood patch: why the rapid response? Anesth Analg 72:129–130PubMedCrossRef

74.

Martin R, Jourdain S, Clairoux M, Tétrault JP (1994) Duration of decubitus position after epidural blood patch. Can J Anaesth 41:23–25PubMedCrossRef

75.

Paech MJ, Doherty DA, Christmas T, Wong CA (2011) The volume of blood for epidural blood patch in obstetrics: a randomized, blinded clinical trial. Anesth Analg 113:126–133PubMedCrossRef

76.

van Kooten F, Oedit R, Bakker SL, Dippel DW (2008) Epidural blood patch in post dural puncture headache: a randomised, observer-blind, controlled clinical trial. J Neurol Neurosurg Psychiatry 79:553–558PubMedCrossRef

77.

Taivainen T, Pitkänen M, Tuominen M, Rosenberg PH (1993) Efficacy of epidural blood patch for postdural puncture headache. Acta Anaesthesiol Scand 37:702–705PubMedCrossRef

78.

Weinschenk S (2013) Neuraltherapie – die Therapie mit Lokalanästhetika: Der aktuelle Stand des Wissens. Dtsch Z Akupunkt 56:17–20CrossRef

79.

Katz D, Beilin Y (2017) Review of the alternatives to epidural blood patch for treatment of postdural puncture headache in the parturient. Anesth Analg 124:1219–1228PubMedCrossRef

80.

Niraj G, Kelkar A, Girotra V (2014) Greater occipital nerve block for postdural puncture headache (PDPH): a prospective audit of a modified guideline for the management of PDPH and review of the literature. J Clin Anesth 26:539–544PubMedCrossRef

81.

Akyol F, Binici O, Çakır M (2014) Ultrasound-guided bilateral greater occipital nerve block for the treatment of postdural puncture headache. Turk J Anaesthesiol Reanim 42:40–42PubMedCrossRef

82.

Khonsary SA, Ma Q, Villablanca P, Emerson J, Malkasian D (2013) Clinical functional anatomy of the pterygopalatine ganglion, cephalgia and related dysautonomias: a review. Surg Neurol Int 4:S422–428PubMedPubMedCentralCrossRef

83.

Mojica J, Mo B, Ng A (2017) Sphenopalatine ganglion block in the management of chronic headaches. Curr Pain Headache Rep 21:27PubMedCrossRef

84.

Jespersen MS, Jaeger P, Ægidius KL, Fabritius ML, Duch P et al (2020) Sphenopalatine ganglion block for the treatment of postdural puncture headache: a randomised, blinded, clinical trial. Br J Anaesth 124:739–747PubMedCrossRef

85.

Cohen S, Levin D, Mellender S, Zhao R, Patel P et al (2018) Topical sphenopalatine ganglion block compared with epidural blood patch for postdural puncture headache management in postpartum patients: a retrospective review. Reg Anesth Pain Med 43:880–884PubMed

86.

Kent S, Mehaffey G (2016) Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in obstetric patients. J Clin Anesth 34:194–196PubMedCrossRef

87.

Youssef HA, Abdel-Ghaffar HS, Mostafa MF, Abbas YH, Mahmoud AO et al (2021) Sphenopalatine ganglion versus greater occipital nerve blocks in treating post-dural puncture headache after spinal anesthesia for cesarean section: a randomized clinical trial. Pain Phys 24:E443–e451

88.

Siegler BH, Gruß M, Oehler B, Keßler J, Fluhr H et al (2021) Intranasal lidocaine atomization as novel and noninvasive treatment option for postdural puncture headache : two case reports from obstetric anesthesiology. Anaesthesist 70:392–397PubMedCrossRef

Titel: Postpunktionskopfschmerz in der Geburtshilfe
Pathogenese, Diagnostik und Therapie
verfasst von: Dr. med. Benedikt Hermann Siegler
Dr. med. Beatrice Oehler
Prof. Dr. med. Peter Kranke
Prof. Dr. med. Markus Alexander Weigand
Publikationsdatum: 14.07.2022
Verlag: Springer Medizin
Schlagwörter: Periduralanästhesie
Postdural Puncture Headache
Erschienen in: Die Anaesthesiologie / Ausgabe 8/2022
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI: https://doi.org/10.1007/s00101-022-01171-2

Neu im Fachgebiet AINS

18.04.2024 | Wirbelsäulenmetastase | Nachrichten

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Postpunktionskopfschmerz in der Geburtshilfe

Pathogenese, Diagnostik und Therapie

Zusammenfassung

Neu im Fachgebiet AINS

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

Hochrisiko-Eingriffe für postoperative Übelkeit

Diclofenac-Gel versus Ibuprofen bei akuten Rückenschmerzen

Update AINS

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2022

Die Vorgaben des Gemeinsamen Bundesausschusses zum Akutschmerzmanagement

Wer macht's wie? Anästhesiologisches Management bei operativen Eingriffen am Thorax

„Intensive Care Unit-Acquired Weakness“

„Resuscitative endovascular balloon occlusion of the aorta“ bei schwer verletzten Patienten im Schockraum: eine Fallserie

Trachealriss nach Intubation bei Notsectio

Erst Regionalanästhesie , dann „Rebound pain“

Neu im Fachgebiet AINS

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

Hochrisiko-Eingriffe für postoperative Übelkeit

Diclofenac-Gel versus Ibuprofen bei akuten Rückenschmerzen

Update AINS