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[Postdural puncture headache after neuraxial anesthesia: incidence and risk factors]. / Postpunktioneller Kopfschmerz nach rückenmarknahen Anästhesieverfahren: Inzidenz und Risikofaktoren.
Weinrich, J; von Heymann, C; Henkelmann, A; Balzer, F; Obbarius, A; Ritschl, P V; Spies, C; Niggemann, P; Kaufner, L.
Affiliation
  • Weinrich J; Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Deutschland.
  • von Heymann C; Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, Berlin, 10249, Deutschland.
  • Henkelmann A; Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Deutschland.
  • Balzer F; Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Deutschland.
  • Obbarius A; Medizinische Klinik mit Schwerpunkt Psychosomatik, Zentrum für Innere Medizin und Dermatologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Deutschland.
  • Ritschl PV; Chirurgische Klinik, Campus Charité Mitte/Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Deutschland.
  • Spies C; Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Deutschland.
  • Niggemann P; Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Deutschland.
  • Kaufner L; Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Deutschland. lutz.kaufner@charit
Anaesthesist ; 69(12): 878-885, 2020 Dec.
Article in De | MEDLINE | ID: mdl-32936349
ABSTRACT
BACKGROUND/

OBJECTIVE:

Postdural puncture headache (PDPH) is a severe complication after spinal anesthesia. The aim of this study was to investigate the incidence of PDPH in two different operative cohorts and to identify risk factors for its occurrence as well as to analyze its influence on the duration of hospital stay. MATERIAL AND

METHODS:

In a retrospective study over a period of 3 years (2010-2012), 341 orthopedic surgery (ORT) and 2113 obstetric (OBS) patients were evaluated after spinal anesthesia (SPA). Data were statistically analyzed using (SPSS-23) univariate analyses with the Mann-Whitney U­test, χ2-test and Student's t-test as well as logistic regression analysis.

RESULTS:

The incidence of PDPH was 5.9% in the ORT cohort and 1.8% in the OBS cohort. Patients with PDPH in the ORT cohort were significantly younger (median 38 years vs. 47 years, p = 0.011), had a lower body weight (median 70.5 kg vs. 77 kg, p = 0.006) and a lower body mass index (median 23.5 vs. 25.2, p = 0.037). Body weight (odds ratio (97.5 % Confidence Intervall [CI]), OR 0.956 97.5% CI 0.920-0.989, p = 0.014) as well as age (OR 0.963 97.5% CI 0.932-0.991, p = 0.015) were identified as independent risk factors for PDPH. In OBS patients, PDPH occurred more frequently after spinal epidural anesthesia than after combined spinal epidural anesthesia (8.6% vs. 1.2%, p < 0.001) and the type of neuraxial anesthesia was identified as an independent risk factor for PDPH (OR 0.049; 97.5% CI 0.023-0.106, p < 0.001). In both groups the incidence of PDPH was associated with a longer hospital stay (ORT patients 4 days vs. 2 days, p = 0.001; OBS patients 6 days vs. 4 days, p < 0.0005).

CONCLUSION:

The incidence of PDPH was different in the two groups with a higher incidence in the ORT but considerably lower than in the literature. Age, constitution and type of neuraxial anesthesia were identified as risk factors of PDPH. Considering the functional imitations (mobilization, neonatal care) and a longer hospital stay, future studies should investigate the impact of an early treatment of PDPH.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Post-Dural Puncture Headache / Anesthesia, Spinal Type of study: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Female / Humans / Newborn / Pregnancy Language: De Journal: Anaesthesist Year: 2020 Document type: Article
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Post-Dural Puncture Headache / Anesthesia, Spinal Type of study: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Female / Humans / Newborn / Pregnancy Language: De Journal: Anaesthesist Year: 2020 Document type: Article