作者: C. L. BRADBURY , S. I. SINGH , S. R. BADDER , L. J. WAKELY , P. M. JONES
DOI: 10.1111/AAS.12047
关键词:
摘要: Post-dural puncture headaches (PDPHs) present an important clinical problem. We assessed methods to decrease accidental dural punctures (ADPs) and interventions reduce PDPH following ADP. Multiple electronic databases were searched for randomised trials (RCTs) of parturients having labour epidurals, in which the studied intervention could plausibly affect ADP or PDPH, incidence at least one these was recorded. Forty RCTs (n = 11,536 epidural insertions) included, studying combined spinal-epidurals (CSEs), loss resistance medium, prophylactic blood patches, needle bevel orientation, ultrasound-guided insertion, morphine, Special Sprotte needles, acoustic-guided administration cosyntropin, continuous spinal analgesia. The CSE, patches meta-analysed. Five reduced PDPH: patch {four trials, median quality score 2, risk difference -0.48 [95% confidence interval (CI): -0.88 -0.086]}, lateral positioning upon insertion (one trial, 1), needles [one 5, -0.44 (95% CI: -0.67 -0.21)], morphine 4, -0.36 CI -0.59 -0.13)], cosyntropin -0.55 -0.16)]. Several potentially PDPH. are thus far each supported by a single, albeit good trial. Prophylactic three but had flawed methodology. Mostly, limited quality, further well-conducted, large studies needed.