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Background: Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. Methods: Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. Results: A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19–1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score≤3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. Conclusions: Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP.
Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study
Gupta A.;von Heymann C.;Magnuson A.;Alahuhta S.;Fernando R.;Van de Velde M.;Mercier F. J.;Schyns-van den Berg A. M. J. V.;Isabelle C.;Bart B.;Filiep S.;Pierre-Yves D.;Geraldine L.;Jan C.;Roel S.;Patrick V. H.;Alain K.;Henk V.;Monique B.;Eva R.;Ana J.;Aleksandra J.;Damjan M.;Ivan S.;Slobodan M.;Martina K.;Petr S.;Milan A.;Christian K.;Ivana V.;Blazena Z.;Christina F. -F.;Bjoern M.;Charlotte K. A.;Tomi K.;Seppo A.;Anne M.;Susanna M.;Kati R.;Tuula H.;Vesa K.;Kirsti L.;Sara T.;Emmanuel B.;Pierre-Edouard G.;Olivier M.;Aurelie C.;Jean L.;Therese S.;Marie B.;Tarik H.;Fleur M. D.;Christine Q.;Karim B.;Agnes L.;Mickael S.;Marie-Pierre B.;Mathieu C.;Catherine F.;Paola-Carla P.;Martine B.;Brigitte S.;Anne-Sophie B.;Thomas D.;Minh N. T.;Hawa K.;Sophie N.;Lauranne O.;Anne D.;Florence V.;Lutz K.;Christoph H.;Stefan M.;Karin B.;Manfred B.;Heidrun L.;Josef S. S.;Ellis M.;Birgit B.;Claudia N.;Stefan W.;Matthias G.;Henning O.;Antonia H.;Yvonne J.;Peter K.;Christian V. H.;Sabine W.;Chryssoula S.;Antonia S.;Athanasia T.;Konstantina K.;Anastasia L.;Dimitrios V.;Paraskevi M.;Adalbjorn T.;Riad T.;Eidelman Leonid A.;Atara D.;Sharon O. -Z.;Alexander I.;Iacob R.;Luigi D. S.;Barbara P.;Luca B.;Alessandro Z.;Michela C.;Giorgio D. R.;Marco A.;Grazia F. M.;Cristina T.;Qamile M.;Andrius M.;Grazina K.;Kestutis R.;Francis B.;Carl T.;Agnes Geertje K. -V.;Alexandra S. -V. D. B.;Markus H. W.;Tijs V. D. B.;Eric K.;Ilse D.;Anouk V. D. K.;Caroline V. D. M.;Nele R.;Michal P.;Christine P.;Marjolein V. D. N.;Seppe K.;Aart-Jan T.;Dick C.;van Nick D.;Bastiaan V.;Ingrid B.;Vegard D.;Robert H.;Francesco V.;Reidar E. J.;Radovan W.;Naz A. T.;Else-Marie R.;Radoslaw C.;Tomasz S.;Bartlomiej W.;Aida F. M.;Amelia F.;Catarina S. A.;Irene F.;Bernardo M.;Joana T.;Rita A.;Herminia C.;Rosario F.;Paulo L.;Carolina C.;Fernando M.;Cristiana P.;Sandra P.;Francisca T.;Pedro V.;Filipa L.;Paulo M.;Lucindo O.;Isabel G. -A.;Vitor P. -O.;Paulo P.;Carla B.;Francisco G.;Ana M.;Claudia C.;Miriam N.;Vania P.;Mara C.;Raquel T.;Gloria T.;Ines F.;Estela P.;Luisa M.;Manue S.;Aleksandra B.;Mirjana K.;Lidija J.;Borislava P.;Marija K.;Monika G.;Jana S.;Gordana P.;Ales R.;Iva B.;Dragan G.;Tatjana S. P.;Teresa C.;Pablo M.;De Joaquin C. -E.;Roque G. -C.;Leonor V. -G.;Morena B.;Carolina G. B.;Cristian H.;Laura R.;De Maroto Pinar S.;Gracia Solsona J. A.;Manuel L. -B.;Marta M. M.;Ana Maria P. M.;Lourdes T.;Anibal Ricardo P. G.;Clara A. S.;Enric M.;Laura R.;Jose Luis A. S.;Maria S. P.;Maria Inmaculada V. H.;Gorka A.;Estibaliz B.;Julia H.;Fernando I.;Alberto M.;Fernando G.;Emilia G. A.;Fabrizio I.;Julieta L.;Cristina R. R.;Osvaldo Ceferino P. P.;Natalia S. B.;Ceferina S. C.;Lourdes H. G.;Caridad R. G.;Raquel S. N.;Diego A.;Belena J. M.;Carmen G. -C.;Irene G.;Susana M.;Elena S.;Anette H.;Elisabet A.;Helena H.;Monika T.;Ruaa A. -T.;Susanne L. -E.;Anja L. -S.;Ola R.;Evija A.;Lars G.;Bijan D.;Anil G.;Nordstom Johan L.;Jan P.;Jan R.;Lars B.;Johan F.;Malin U. E.;Hakan R.;Anna H.;Katarina L.;Sofus R.;Karin T.;Peter B.;Moira R. B.;Ulrike S.;Stanislas M.;Georges S.;Pia A. D. M.;Miodrag F.;Alexander D.;Maya B.;Thierry G.;Claudia V.;Sule O.;Berrin G. D.;Pelin C. D.;Ayca T. T.;Sarah D.;Marc V. D. V.;Manuel A.;Marina V.;Leire M.;Rosa S.;Brazzi L
2020-01-01
Abstract
Background: Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. Methods: Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. Results: A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19–1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score≤3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. Conclusions: Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP.
Gupta A.; von Heymann C.; Magnuson A.; Alahuhta S.; Fernando R.; Van de Velde M.; Mercier F.J.; Schyns-van den Berg A.M.J.V.; Isabelle C.; Bart B.; Fi...espandi
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1764974
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simulazione ASN
Il report seguente simula gli indicatori relativi alla produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione.
La simulazione si basa sui dati IRIS e presenta gli indicatori calcolati alla data indicata sul report. Si ricorda che in sede di domanda ASN presso il MIUR gli indicatori saranno invece calcolati a partire dal 1° gennaio rispettivamente del quinto/decimo/quindicesimo anno precedente la scadenza del quadrimestre di presentazione della domanda (art 2 del DM 598/2018).
In questa simulazione pertanto il valore degli indicatori potrà differire da quello conteggiato all’atto della domanda ASN effettuata presso il MIUR a seguito di:
Correzioni imputabili a eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori.
Presenza di eventuali errori di catalogazione e/o dati mancanti in IRIS
Variabilità nel tempo dei valori citazionali (per i settori bibliometrici)
Variabilità della finestra temporale considerata in funzione della sessione di domanda ASN a cui si partecipa.
La presente simulazione è stata realizzata sulla base delle regole riportate nel DM 598/2018 e dell'allegata Tabella A e delle specifiche definite all'interno del Focus Group Cineca relativo al modulo IRIS ER. Il Cineca non si assume alcuna responsabilità in merito all'uso che il diretto interessato o terzi faranno della simulazione.
