@article{3103506,
    title = "Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study",
    author = "Gupta, A. and von Heymann, C. and Magnuson, A. and Alahuhta, S. and Fernando, R. and Van de Velde, M. and Mercier, F.J. and Schyns-van den Berg, A.M.J.V. and Isabelle, C. and Bart, B. and Filiep, S. and Pierre-Yves, D. and Geraldine, L. and Jan, C. and Roel, S. and Patrick, V.H. and Alain, K. and Henk, V. and Monique, B. and Eva, R. and Ana, J. and Aleksandra, J. and Damjan, M. and Ivan, S. and Slobodan, M. and Kosinova, M. and Stourac, P. and Milan, A. and Christian, K. and Ivana, V. and Blažena, Z. and Christina, F.-F. and Bjoern, M. and Charlotte, K.A. and Tomi, K. and Seppo, A. and Anne, M. and Susanna, M. and Kati, R. and Tuula, H. and Vesa, K. and Kirsti, L. and Sara, T. and Emmanuel, B. and Pierre-Édouard, G. and Olivier, M. and Aurelie, C. and Jean, L. and Thérèse, S. and Marie, B. and Tarik, H. and Fleur, M.D. and Christine, Q. and Karim, B. and Agnès, L. and Mickaël, S. and Marie-Pierre, B. and Mathieu, C. and Catherine, F. and Paola-Carla, P. and Martine, B. and Brigitte, S. and Anne-Sophie, B. and Thomas, D. and Minh, N.T. and Hawa, K. and Sophie, N. and Lauranne, O. and Anne, D. and Florence, V. and Lutz, K. and Christoph, H. and Stefan, M. and Karin, B. and Manfred, B. and Heidrun, L. and Josef, S.S. and Ellis, M. and Birgit, B. and Claudia, N. and Stefan, W. and Matthias, G. and Henning, O. and Antonia, H. and Yvonne, J. and Peter, K. and Christian, V.H. and Sabine, W. and Chryssoula, S. and Antonia, S. and Athanasia, T. and Konstantina, K. and Anastasia, L. and Dimitrios, V. and Paraskevi, M. and Adalbjörn, T. and Riad, T. and Eidelman Leonid, A. and Atara, D. and Sharon, O.-Z. and Alexander, I. and Iacob, R. and Luigi, D.S. and Barbara, P. and Luca, B. and Alessandro, Z. and Michela, C. and Giorgio, D.R. and Marco, A. and Grazia, F.M. and Cristina, T. and Qamile, M. and Andrius, M. and Grazina, K. and Kestutis, R. and Francis, B. and Carl, T. and Agnes Geertje, K.-V. and Alexandra, S.-V.D.B. and Markus, H.W. and Tijs, V.D.B. and Eric, K. and Ilse, D. and Anouk, V.D.K. and Caroline, V.D.M. and Nele, R. and Michal, P. and Christine, P. and Marjolein, V.D.N. and Seppe, K. and Aart-Jan, T. and Dick, C. and van Nick, D. and Bastiaan, V. and Ingrid, B. and Vegard, D. and Robert, H. and Francesco, V. and Reidar, E.J. and Radovan, W. and Naz, A.T. and Else-Marie, R. and Radosław, C. and Tomasz, S. and Bartłomiej, W. and Aida, F.M. and Amélia, F. and Catarina, S.A. and Irene, F. and Bernardo, M. and Joana, T. and Rita, A. and Herminia, C. and Rosario, F. and Paulo, L. and Carolina, C. and Fernando, M. and Cristiana, P. and Sandra, P. and Francisca, T. and Pedro, V. and Filipa, L. and Paulo, M. and Lucindo, O. and Isabel, G.-A. and Vitor, P.-O. and Paulo, P. and Carla, B. and Francisco, G. and Ana, M. and Cláudia, C. and Miriam, N. and Vânia, P. and Mara, C. and Raquel, T. and Glória, T. and Inês, F. and Estela, P. and Luísa, M. and Manue, S. and Aleksandra, B. and Mirjana, K. and Lidija, J. and Borislava, P. and Marija, K. and Monika, G. and Jana, S. and Gordana, P. and Ales, R. and Iva, B. and Dragan, G. and Tatjana, S.P. and Teresa, C. and Pablo, M. and De Joaquin, C.-E. and Roque, G.-C. and Leonor, V.-G. and Morena, B. and Carolina, G.B. and Cristian, H. and Laura, R. and De Maroto Pinar, S. and Gràcia Solsona, J.A. and Manuel, L.-B. and Marta, M.M. and Ana María, P.M. and Lourdes, T. and Anibal Ricardo, P.G. and Clara, A.S. and Enric, M. and Laura, R. and Jose Luis, A.S. and Maria, S.P. and Maria Inmaculada, V.H. and Gorka, A. and Estíbaliz, B. and Julia, H. and Fernando, I. and Alberto, M. and Fernando, G. and Emilia, G.A. and Fabrizio, I. and Julieta, L. and Cristina, R.R. and Osvaldo Ceferino, P.P. and Natalia, S.B. and Ceferina, S.C. and Lourdes, H.G. and Caridad, R.G. and Raquel, S.N. and Diego, A. and Beleña, J.M. and Carmen, G.-C. and Irene, G. and Susana, M. and Elena, S. and Anette, H. and Elisabet, A. and Helena, H. and Monika, T. and Ruaa, A.-T. and Susanne, L.-E. and Anja, L.-S. and Ola, R. and Evija, A. and Lars, G. and Bijan, D. and Anil, G. and Nordstöm Johan, L. and Jan, P. and Jan, R. and Lars, B. and Johan, F. and Malin, U.E. and Håkan, R. and Anna, H. and Katarina, L. and Sofus, R. and Karin, T. and Peter, B. and Moira, R.B. and Ulrike, S. and Stanislas, M. and Georges, S. and Pia, A.D.M. and Miodrag, F. and Alexander, D. and Maya, B. and Thierry, G. and Claudia, V. and Sule, O. and Berrin, G.D. and Pelin, C.D. and Ayca, T.T. and Sarah, D. and Marc, V.D.V. and Manuel, A. and Marina, V. and Leire, M. and Rosa, S.",
    journal = "BRITISH JOURNAL OF ANAESTHESIA",
    year = "2020",
    volume = "125",
    number = "6",
    pages = "1045-1055",
    publisher = "Elsevier Ireland Ltd",
    issn = "0007-0912",
    doi = "10.1016/j.bja.2020.07.061",
    keywords = "caffeine;  local anesthetic agent;  nonsteroid antiinflammatory agent;  opiate;  paracetamol, adult;  Article;  aseptic meningitis;  backache;  blood patch;  body mass;  brain hemorrhage;  cerebrospinal fluid;  cesarean section;  clinical practice;  cohort analysis;  conservative treatment;  controlled study;  epidural analgesia;  epidural anesthesia;  female;  follow up;  headache;  human;  lumbar puncture;  major clinical study;  multicenter study;  multipara;  observational study;  parity;  postdural puncture headache;  priority journal;  prospective study;  spinal anesthesia;  subdural hematoma;  treatment duration;  treatment outcome;  adolescent;  adverse event;  blood patch;  brain hemorrhage;  clinical trial;  disease management;  middle aged;  obstetrics;  pain measurement;  postdural puncture headache;  pregnancy;  procedures;  young adult, Adolescent;  Adult;  Analgesia, Epidural;  Blood Patch, Epidural;  Cohort Studies;  Disease Management;  Female;  Follow-Up Studies;  Humans;  Intracranial Hemorrhages;  Middle Aged;  Obstetrics;  Pain Measurement;  Post-Dural Puncture Headache;  Pregnancy;  Prospective Studies;  Young Adult",
    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. © 2020 British Journal of Anaesthesia"
}