Consensus Practice Guidelines on Postdural Puncture Headache From a Multisociety, International Working Group: A Summary Report

Vishal Uppal, Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Halifax, Nova Scotia, Canada.
Robin Russell, Nuffield Department of Anaesthetics, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, England.
Rakesh Sondekoppam, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City.
Jessica Ansari, Anesthesia Department, Stanford Health Care, Stanford, California.
Zafeer Baber, Department of Anesthesiology and Perioperative Medicine, Newton-Wellesley Hospital, Tufts University School of Medicine, Boston, Massachusetts.
Yian Chen, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California.
Kathryn DelPizzo, Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York.
Dan Sebastian Dîrzu, Department of Anaesthesia and Intensive Care, Emergency County Hospital, Cluj-Napoca, Romania.
Hari Kalagara, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida.
Narayan R. Kissoon, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
Peter G. Kranz, Department of Radiology, Duke University Medical Center, Durham, North Carolina.
Lisa Leffert, Yale University School of Medicine, Yale New Haven Hospital and Bridgeport Hospital, New Haven, Connecticut.
Grace Lim, Department of Anesthesiology and Perioperative Medicine, Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Magee Hospital, Pittsburgh, Pennsylvania.
Clara A. Lobo, Anesthesiology Institute, Interventional Pain Medicine Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
Dominique Nuala Lucas, Department of Anaesthesia, London Northwest University Healthcare NHS Trust, London, England.
Eleni Moka, Anaesthesiology Department, Creta Interclinic Hospital-Hellenic Healthcare Group, Heraklion, Crete, Greece.
Stephen E. Rodriguez, Walter Reed National Military Medical Center, Bethesda, Maryland.
Herman Sehmbi, Department of Anesthesia, University of Western Ontario, London, Ontario, Canada.
Manuel C. Vallejo, Medical Education, Anesthesiology, Obstetrics and Gynecology, West Virginia University, Morgantown.
Thomas Volk, Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, Saarbrücken, Germany.
Samer Narouze, Rootstown and Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio.

Document Type

Article

Publication Title

JAMA network open

Abstract

IMPORTANCE: Postdural puncture headache (PDPH) can follow unintentional dural puncture during epidural techniques or intentional dural puncture during neuraxial procedures, such as a lumbar puncture or spinal anesthesia. Evidence-based guidance on the prevention, diagnosis, and management of this condition is, however, currently lacking. OBJECTIVE: To fill the practice guidelines void and provide comprehensive information and patient-centric recommendations for preventing, diagnosing, and managing PDPH. EVIDENCE REVIEW: With input from committee members and stakeholders of 6 participating professional societies, 10 review questions that were deemed important for the prevention, diagnosis, and management of PDPH were developed. A literature search for each question was performed in MEDLINE on March 2, 2022. Additional relevant clinical trials, systematic reviews, and research studies published through March 2022 were also considered for practice guideline development and shared with collaborator groups. Each group submitted a structured narrative review along with recommendations that were rated according to the US Preventive Services Task Force grading of evidence. Collaborators were asked to vote anonymously on each recommendation using 2 rounds of a modified Delphi approach. FINDINGS: After 2 rounds of electronic voting by a 21-member multidisciplinary collaborator team, 47 recommendations were generated to provide guidance on the risk factors for and the prevention, diagnosis, and management of PDPH, along with ratings for the strength and certainty of evidence. A 90% to 100% consensus was obtained for almost all recommendations. Several recommendations were rated as having moderate to low certainty. Opportunities for future research were identified. CONCLUSIONS AND RELEVANCE: Results of this consensus statement suggest that current approaches to the treatment and management of PDPH are not uniform due to the paucity of evidence. The practice guidelines, however, provide a framework for individual clinicians to assess PDPH risk, confirm the diagnosis, and adopt a systematic approach to its management.

First Page

e2325387

DOI

10.1001/jamanetworkopen.2023.25387

Publication Date

8-1-2023

Identifier

37581893 (pubmed); 10.1001/jamanetworkopen.2023.25387 (doi); 2808365 (pii)

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