Long-term morbidities following unintentional dural puncture in obstetric patients: A systematic review and meta-analysis.
J Clin Anesth
; 79: 110787, 2022 08.
Article
in En
| MEDLINE
| ID: mdl-35358942
ABSTRACT
STUDY OBJECTIVE:
To investigate the association of unintentional dural puncture (UDP) and postdural puncture headache (PDPH) with the risk of chronic headache, backache, neckache and depression. We also investigated if epidural blood patch (EBP) is associated with reduced risk of these morbidities.DESIGN:
Systematic review and meta-analysis. PATIENTS Pregnant women who experienced UDP and/or PDPH versus those who had uneventful neuraxial procedures, and women who received EBP versus those who did not.INTERVENTIONS:
None. MEASUREMENTS Primary outcomes were headache, backache, and neckache lasting ≥12 months, and depression ≥1 month. Secondary outcomes included chronic headache, backache, and neckache persisting ≥1 and ≥ 6 months, and the effects of EBP on those outcomes at ≥1 and ≥ 12 months. Subgroup analyses of prospective studies and sensitivity analyses of primary outcomes excluding poor quality studies were performed. MAINRESULTS:
Twelve studies compared 6541 women with UDP and/or PDPH versus 1,004,510 with uncomplicated neuraxial procedures. Eight studies compared EBP (n = 3610) with no EBP (n = 3154). UDP and/or PDPH were associated with increased risk of headache (RR 3.95; 95%CI 2.13 to 7.34; I2 42%), backache (RR 2.72; 95%CI 2.04 to 3.62; I2 1%), and neckache (RR 8.09; 95%CI 1.03 to 63.35) persisting ≥12 months, and depression (RR 3.12; 95%CI 1.44 to 6.77; I2 90%) lasting ≥1 month. Results were consistent in analyses at ≥1 and ≥ 6 months, subgroup analyses of prospective studies, and after exclusion of one poor-quality study from our primary outcome. EBP was not associated with significant reduction in the risk of long-term morbidities.CONCLUSIONS:
UDP and/or PDPH were associated with increased risk of chronic headache, backache, neckache, and depression. EBP was not associated with a significant reduction in those risks, but this conclusion is limited by the heterogeneity of current data and lack of information on the success of EBP in relieving acute PDPH symptoms.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Headache Disorders
/
Post-Dural Puncture Headache
Type of study:
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
/
Systematic_reviews
Limits:
Female
/
Humans
/
Male
/
Pregnancy
Language:
En
Journal:
J Clin Anesth
Journal subject:
ANESTESIOLOGIA
Year:
2022
Type:
Article
Affiliation country:
United States