Advertisement

Postpunktioneller Kopfschmerz

  • K. Radke
  • O.C. Radke

Zusammenfassung

Kopfschmerzen nach Durapunktion sind eine typische Nebenwirkung rückenmarknaher Analgesie verfahren und können zu erheblichen Einschränkungen im Alltag des Patienten führen. Mit dünnen, atraumatischen Nadeln und spezieller Punktionstechnik (z. B. Wiedereinführen des Mandrins) kann ein großer Teil der Kopfschmerzen nach Spinalanästhesien vermieden werden. Zu den wirksamen Maßnahmen, die nach einer akzidentellen Durapunktion das Risiko von postpunktionellem Kopfschmerz verringern, gehört die rückenmarknahe Applikation von Morphin. Steht nach Ausschluss wichtiger, potenziell lebensbedrohlicher Differenzialdiagnosen die Diagnose postpunktionelle Kopfschmerzen fest, sind die Gaben von Koffein oder Theophyllin und Nichtopioidanalgetika wirksam zur Linderung der Symptome. Traditionelle Maßnahmen wie prophylaktische Bettruhe und Hyperhydratation werden nicht mehr empfohlen. Wird eine Intervention notwendig, ist der epidurale Blut-Patch (EBP) mit einer hohen Erfolgsrate weiterhin die Methode der Wahl.

Schlüsselwörter

Liquorpunktion Dura mater Nadeln Koffein Epiduraler Blut -Patch 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literature

  1. 1.
    Alstadhaug KB, Odeh F, Baloch FK etal (2012) Post-lumbar punctu-re headache.Tidsskr Nor Laegeforen 132:818–821PubMedGoogle Scholar
  2. 2.
    Turnbull DK, Shepherd DB (2003) Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth 91:718–729PubMedGoogle Scholar
  3. 3.
    Bezov D, Ashina S, Lipton R (2010) Post-dural puncture headache. Part II: prevention, management, and prognosis. Headache 50:1482–1498PubMedGoogle Scholar
  4. 4.
    Ahmed SV, JayawarnaC, Ju de E (2006) Post lumbar punc ture headache: diagnosis and management. Postgrad Med J 82:713–716PubMedPubMedCentralGoogle Scholar
  5. 5.
    Vandam LD, Dripps RD (1956) Longterm follow-up of patients who received 10,098 spinal anesthetics; Syndrome ofdecreased intracranial pressure (headache and ocular and auditory difficulties). J Am Med Assoc 161:586–591Google Scholar
  6. 6.
    Apfel CC, Saxena A, Cakmakkaya OS et al (2010) Prevention of postdu ral puncture headache after accidental dural puncture: a quantitati ve systematic review. Br J Anaesth 105:255–263PubMedGoogle Scholar
  7. 7.
    Kleine-Brüggeney M, Kranke P, Stamer UM (2011) Prophylaxis and therapy of postdural puncture headache-a critical evaluation of treat ment options. Anasthesiol Intensivmed Notfallmed Schmerzther 46:516–524Google Scholar
  8. 8.
    Sprigge JS, Harper SJ (2008) Accidental dural puncture and post dural puncture headache in obstetric anaesthesia: presentation and manage ment: a 23-year survey in a district general hospital. Anaesthesia 63:36 4–3Google Scholar
  9. 9.
    Bezov D, Lipton RB, Ashina S (2010) Post-dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiology. Headache 50:1144–1152PubMedGoogle Scholar
  10. 10.
    Reamy BV (2009) Post-epidural headache: how late can it occur? J Am Board Fam Med 22:202–205PubMedGoogle Scholar
  11. 11.
    Tohmo H, Vuorinen E, MuuronenA (1998) Prolonged impairment in activities of daily living due to postdu ral puncture headache after diagnostic lumbar puncture. Anaesthesia 53:299–302PubMedCrossRefGoogle Scholar
  12. 12.
    Stella CL, Jodicke CD, How HY et al (2007) Postpartum headache: is your work-up complete? Am J Obstet Gynecol 196:318.e1 -318.e7Google Scholar
  13. 13.
    Zeidan A, Farhat O, Maaliki H, Baraka A (2006) Does postdural puncture headache left untreated lead to sub dural hematoma? Case report and review of the literature. Int J Obstet Anesth 15:50–58PubMedGoogle Scholar
  14. 14.
    Ready LB, Cuplin S, Haschke RH, Nessly M (1989) Spinal needle determinants of rate of transdural fluid leak. Anesth Anaig 69:457–460Google Scholar
  15. 15.
    CruickshankRH, HopkinsonJM (1989) Fluid flow through dural puncture sites. Anaesthesia 44:415 41–8Google Scholar
  16. 16.
    Liu S, Carpenter RL, Neal JM (1995) Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology 82:1474–1506PubMedGoogle Scholar
  17. 17.
    Calthorpe N (2004) The history of spinal needles: getting to the point. Anaesthesia 59:1231–1241PubMedCrossRefGoogle Scholar
  18. 18.
    Strupp M, Schueler O, Straube A et al (2001) „Atraumatic" Sprotte needle reduces the incidence of post-lum bar puncture headaches. Neurology 57:2310–2312PubMedCrossRefGoogle Scholar
  19. 19.
    Lybecker H, Moller JT, May O, Nielsen HK (1990) Incidence and prediction of postdural puncture headache. A prospective study of 1021 spinal anesthesias. Anesth Anaig 70:389–394Google Scholar
  20. 20.
    Strupp M, BrandtT, Müller A (1998) Incidence of post-lumbar punctu re Syndrome reduced by reinserting the stylet: a randomized prospec tive study of 600 patients. J Neural 245:589–592Google Scholar
  21. 21.
    Aida S, Taga K, YamakuraTetal (1998) Headache after attempted epidural block: the role of intrathecal air. Anesthesiology 88:76–81PubMedCrossRefGoogle Scholar
  22. 22.
    Beilin Y, Arnold IJelfeyanCetal (2000) Quality of analgesia when air versus saline is used for identifi cation of the epidural space in the parturient. Reg Anesth Pain Med 25:596–599PubMedGoogle Scholar
  23. 23.
    Van de Velde M, Schepers, Berends N et al (2008) Ten years of experience with accidental dural punctu re and post-dural puncture heada che in a tertiary obstetric anaesthe sia department. Int J Obstet Anesth 17:329–335PubMedGoogle Scholar
  24. 24.
    Palmer CM (2010) Continuous spi nal anesthesia and analgesia in obstetrics. Anesth Anaig 111:1476–1479Google Scholar
  25. 25.
    Bujedo BM, Santos SG, Azpiazu AU (2012) A review of epidural and in trathecal opioids used in the ma nagement of postoperative pain. J Opioid Manag 8:177–192PubMedGoogle Scholar
  26. 26.
    Sultan P, Gutierrez MC, Carvalho B (2011) Neuraxial morphine and respiratory depression. Drugs 71:1807–1819PubMedCrossRefGoogle Scholar
  27. 27.
    Pöpping DM, Elia N, Marret E et al (2012) Opioids added to local anest hetics for single-shot intrathecal an esthesia in patients undergoing mi nor surgery: a meta-analysis of ran domized trials. Pain 153:784–793PubMedCrossRefGoogle Scholar
  28. 28.
    Gogarten W, Aken H Van (2010) Überwachungsanforderungen bei rückenmarksnahen Opioiden. Anaesthesiol Intensivmed 51:5–4Google Scholar
  29. 29.
    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 40:710–714Google Scholar
  30. 30.
    Mosavy SH, Shafei M (1975) Preven tion of headache consequent upon dural puncture in obstetric patient. Anaesthesia 30:807–809PubMedCrossRefGoogle Scholar
  31. 31.
    Basurto Ona X, Martinez Garcfa L, Sola I, Bonfill Cosp X (2011) Drugtherapyfortreating post-dural puncture headache. Cochrane Database Syst Rev:CD007887. doi:10.1002/14651858.CD007887. pub2Google Scholar
  32. 32.
    Camann WR, Murray RS, Mushlin PS, Lambert DH (1990) Effects of oral caffeine on postdural puncture hea dache. A double-blind, placebo-controlled trial. Anesth Anaig 70:181–184Google Scholar
  33. 33.
    Jarvis AP, Greenawalt JW, Fagraeus L (1986) Intravenous caffeine for post dural puncture headache. Anesth Anaig 65:316–317Google Scholar
  34. 34.
    Bolton VE, Leicht CH, Scanion TS (1989) Postpartum seizure after epi dural blood patch and intravenous caffeine sodium benzoate. Anesthe siology 70:146–149Google Scholar
  35. 35.
    Eldor J (1995) Opiate treatment of post dural puncture headache. Acta Anaesthesiol Scand 39:114–0Google Scholar
  36. 36.
    Tom DJ, Gulevich SJ, Shapiro HM et al (1992) Epidural blood patch in the HIV-positive patient. Review of clinical experience. San Diego HIV Neurobehavioral Research Center. Anest hesiology 76:943–947Google Scholar
  37. 37.
    Chen L-K, Huang C-H, Jean W-H et al (2007) Effective epidural blood patch volumes for postdural puncture hea dache in Taiwanese women. J Formos Med Assoc 106:134–140Google Scholar
  38. 38.
    Szeinfeld M, Ihmeidan IH, Moser MM etal (1986) Epidural blood patch: evaluation of the volume and spread of blood injected into the epidural space. Anesthesiology 64:820–822PubMedCrossRefGoogle Scholar
  39. 39.
    Hebl JR, HorlockerTT, Chantigian RC, Schroeder DR (1999) Epidural anest hesia and analgesia are not impaired after dural puncture with or without epidural blood patch. Anesth Anaig 89:390–394Google Scholar
  40. 40.
    Rainbird A, Pfitzner J (1983) Restricted spread of analgesia following epidural blood patch. Case report with a review of possible complications. Anaesthesia 38:481–484PubMedGoogle Scholar
  41. 41.
    Jagannathan N, Tetzlaff JE (2005) Epidural blood patch in a Jehovah’s Witness patient with post-dural puncture cephalgia. Can J Anaesth 52:11–3Google Scholar
  42. 42.
    Naja Z, Al-Tannir M, El-Rajab M et al (2009) Nerve stimulator-guided occipital nerve blockade for postdural puncture headache. Pain Pract 9:51 5–8Google Scholar
  43. 43.
    International Headache Society (2012) Internationale Kopfschmerz Klassifikation (ICHD-2). http://ihsdassification.org/de/02_klassifikation/03_teil2/07.02.01_nonvascular. htmGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • K. Radke
    • 1
    • 2
  • O.C. Radke
    • 1
    • 2
  1. 1.Klinik und Poliklinik für Anästhesiologie und IntensivtherapieDresden
  2. 2.Department of Anesthesia & Perioperative (are, San Francisco General HospitalUniversity of (alifornia San FranciscoSan FranciscoCalifornia

Personalised recommendations