Cefaleia pós-punção dural – uma revisão de literatura / Post-dural puncture headache – a literature review

Ana Paula Paschoal, Marcello Pansani Vilaça, Marcello Pansani Vilaça, Aline Rafaela da Silva Rodrigues Machado, Aline Rafaela da Silva Rodrigues Machado, Kelly Regina Torres da Silva, Kelly Regina Torres da Silva, Lucas Gazarini, Lucas Gazarini, André Valério da Silva, André Valério da Silva

Abstract


A cefaleia pós-punção dural (CPPD) é a complicação mais frequente da punção da dura-máter, seja para fins diagnósticos, terapêuticos ou para a administração de anestésicos durante cirurgias. O presente trabalho realizou uma revisão de literatura buscando atualizações acerca da fisiopatologia, diagnóstico, fatores de risco e tratamento da CPPD. O MEDLINE (via PubMed) foi utilizado como base de dados com os seguintes descritores: “post-dural puncture headache”, “incidence”, “risk-factors” e ”therapy”. Foram considerados apenas artigos em inglês e publicados nos últimos 10 anos, e também foi consultada bibliografia complementar. A CPPD resulta da recuperação tardia da dura-máter após sua punção intencional ou não intencional (durante anestesia epidural). A perda liquórica pelo orifício dural aberto leva à hipotensão intracraniana, consequente vasodilatação e tração de estruturas nervosas, estabelecendo o quadro doloroso típico que piora em posição ortostática e melhora ao repouso. O diagnóstico de CPPD é clínico, e o quadro típico da dor é a principal evidência. Fatores de risco como pertencer ao sexo feminino, ser adulto jovem, gestante, história prévia de CPPD, maior calibre da agulha e/ou bisel cortante são descritos. A conduta terapêutica varia de acordo com a gravidade da dor, podendo ser conservadora ou ser realizado o tamponamento sanguíneo peridural. Somente o “blood patch” tem evidências científicas suficientes para ser recomendado como rotina terapêutica invasiva, ainda que não seja isento de complicações. O bloqueio do gânglio esfenopalatino é proposta como uma intervenção analgésica alternativa. Visto que os recursos terapêuticos são limitados, ensaios clínicos controlados e maiores são necessários para que formas robustas de tratamento para CPPD sejam possibilitadas.

 


Keywords


Cefaleia pós-punção dural, Incidência, Fatores de risco, Tratamento

References


ALSTADHAUG, Karl Bjornar et al. Post-lumbar puncture headache. Tidsskr Nor Laegeforen, v. 132, n. 7, p. 818-821, 2012.

AMORIM, Jane A.; GOMES DE BARROS, Mauro V.; VALENÇA, Marcelo M. Post-dural (post-lumbar) puncture headache: risk factors and clinical features. Cephalalgia, v. 32, n. 12, p. 916-923, 2012.

BARDON, Jean et al. Risk factors of post-dural puncture headache receiving a blood patch in obstetric patients. Minerva anestesiologica, v. 82, n. 6, p. 641-648, 2016.

BARRERAS, Paula et al. A dedicated lumbar puncture clinic: performance and short-term patient outcomes. Journal of Neurology, v. 264, n. 10, p. 2075-2080, 2017.

BEZOV, David; LIPTON, Richard B.; ASHINA, Sait. Post‐dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiology. Headache: The Journal of Head and Face Pain, v. 50, n. 7, p. 1144-1152, 2010.

COHEN, Shaul et al. Sphenopalatine ganglion block: a safer alternative to epidural blood patch for postdural puncture headache. Regional Anesthesia & Pain Medicine, v. 39, n. 6, p. 563-563, 2014.

DE ALMEIDA, Sérgio Monteiro et al. Incidence of post‐dural puncture headache in research volunteers. Headache: The Journal of Head and Face Pain, v. 51, n. 10, p. 1503-1510, 2011.

DE LIMA, Rodrigo Andrade et al. Hipertermia maligna: uma revisão da literatura/Malignant hyperthermia: a literature review. Brazilian Journal of Health Review, v. 3, n. 2, p. 2475-2489, 2020.

DODGE, Heather S. et al. Cigarette smokers have reduced risk for post-dural puncture headache. Pain physician, v. 16, n. 1p. E25-E30, 2013.

DRAKE R, VOGL AW, MITCHELL AWM. Gray Anatomia para estudantes. Elsevier Brasil, 2015.

DUITS, Flora H. et al. Performance and complications of lumbar puncture in memory clinics: results of the multicenter lumbar puncture feasibility study. Alzheimer's & Dementia, v. 12, n. 2, p. 154-163, 2016.

ENG, Hillenn Cruz; GHOSH, Shayanti Meela; CHIN, Ki Jinn. Practical use of local anesthetics in regional anesthesia. Current Opinion in Anesthesiology, v. 27, n. 4, p. 382-387, 2014.

FRANZ, Amber M. et al. The effect of second-stage pushing and body mass index on postdural puncture headache. Journal of Clinical Anesthesia, v. 37, p. 77-81, 2017.

FURTADO, Inês; DE LIMA, Isabel Flor; PEDRO, Sérgio. Ropivacaine use in transnasal sphenopalatine ganglion block for post dural puncture headache in obstetric patients–case series. Brazilian Journal of Anesthesiology (English Edition), v. 68, n. 4, p. 421-424, 2018.

GAISER, Robert R. Postdural puncture headache: a headache for the patient and a headache for the anesthesiologist. Current Opinion in Anesthesiology, v. 26, n. 3, p. 296-303, 2013.

HALLER, G. et al. Risk factors for post-dural puncture headache following injury of the dural membrane: a root-cause analysis and nested case-control study. International journal of obstetric anesthesia, v. 36, p. 17-27, 2018.

HAMMOND, Edward R. et al. Needle type and the risk of post-lumbar puncture headache in the outpatient neurology clinic. Journal of the neurological sciences, v. 306, n. 1-2, p. 24-28, 2011.

Headache Classification Subcomittee of the International Headache Society. The International Classification of Headache Disorders: 3rd Edition (ICHD-III), 2018. Disponível em: < https://ichd-3.org/>.

HEPPOLETTE, Chantal A.A. et al. Clinical Pharmacokinetics and Pharmacodynamics of Levobupivacaine. Clinical Pharmacokinetics, p. 1-31, 2020.

HOFER, Jennifer E.; SCAVONE, Barbara M. Cranial nerve VI palsy after dural-arachnoid puncture. Anesthesia & Analgesia, v. 120, n. 3, p. 644-646, 2015.

HOLLISTER, N. et al. Minimising the risk of accidental dural puncture with epidural analgesia for labour: a retrospective review of risk factors. International journal of obstetric anesthesia, v. 21, n. 3, p. 236-241, 2012.

IMBELLONI, Luiz Eduardo et al. Anestesia geral versus raquianestesia para colecistectomia videolaparoscópica. Revista Brasileira de Anestesiologia, v. 60, n. 3, p. 217-227, 2010.

JESPERSEN, Mads S. et al. Sphenopalatine ganglion block for the treatment of postdural puncture headache: a randomised, blinded, clinical trial. British Journal of Anaesthesia, pii:S0007-0912, n. 20, p. 30164-1, 2020.

KENT, Sheffield; MEHAFFEY, Greg. Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in the ED. The American journal of emergency medicine, v. 33, n. 11, p. 1714. e1-1714. e2, 2015.

LAVI, Ronit; ROWE, J. M.; AVIVI, Irit. Lumbar puncture: it is time to change the needle. European Neurology, v. 64, n. 2, p. 108-113, 2010.

LIANG, Buqing et al. Predictors and incidence of orthostatic headache associated with lumbar drain placement following endoscopic endonasal skull base surgery. Acta Neurochirurgica, v. 159, n. 8, p. 1379-1385, 2017.

LJUBISAVLJEVIC, Srdjan et al. Parameters Related to Lumbar Puncture Do not Affect Occurrence of Postdural Puncture Headache but Might Influence Its Clinical Phenotype. World Neurosurgery, v. 133, p. e540-e550, 2020.

MIU, M.; PAECH, M. J.; NATHAN, E. The relationship between body mass index and post-dural puncture headache in obstetric patients. International journal of obstetric anesthesia, v. 23, n. 4, p. 371-375, 2014.

MONSERRATE, Andrés E. et al. Factors associated with the onset and persistence of post–lumbar puncture headache. JAMA Neurology, v. 72, n.3, p. 325-332, 2015.

MURPHY, Casey A.; MCBRIDE, Daniel; SHARMA, Sanjay. Sphenopalatine Ganglion Block for Postdural Puncture Headache. Pain Medicine, pii: pnz351, 2020.

NAIR, Abhijit S.; RAYANI, Basanth Kumar. Sphenopalatine ganglion block for relieving postdural puncture headache: technique and mechanism of action of block with a narrative review of efficacy. The Korean journal of pain, v. 30, n. 2, p. 93-97, 2017.

NOWACZEWSKA, Magdalena; KSIĄŻKIEWICZ, Barbara. Cerebral blood flow characteristics in patients with post-lumbar puncture headache. Journal of neurology, v. 259, n. 4, p. 665-669, 2012.

ONA, Xavier Basurto; OSORIO, Dimelza; COSP, Xavier Bonfill. Drug therapy for treating post‐dural puncture headache. Cochrane database of systematic reviews, n. 7, 2015.

PARK, K. M. et al. Does lumbar puncture at night prevent post‐dural puncture headache? Acta Neurologica Scandinavica, v. 130, n.3, p. 204-9, 2014.

PERALTA, Feyce et al. The relationship of body mass index with the incidence of postdural puncture headache in parturients. Anesthesia & Analgesia, v. 121, n. 2, p. 451-456, 2015.

PIRBUDAK, Lütfiye; ÖZCAN, Halil Ibrahim; TÜMTÜRK, Pınar. Postdural puncture headache: Incidence and predisposing factors in a university hospital. Ağrı, v. 31, n. 1, p. 1-8, 2019.

RUSSELL, R. et al. Treatment of obstetric post-dural puncture headache. Part 1: conservative and pharmacological management. International journal of obstetric anesthesia, v. 38, p. 93-103, 2019.

SHAPARIN, Naum. et al. Timing of neuraxial pain interventions following blood patch for post dural puncture headache. Pain physician, v. 17, p. 119-125, 2014.

XU, Hong et al. Comparison of cutting and pencil-point spinal needle in spinal anesthesia regarding postdural puncture headache: A meta-analysis. Medicine, v. 96, n. 14, 2017.

ZORRILLA-VACA, Andres et al. The impact of spinal needle selection on postdural puncture headache: a meta-analysis and metaregression of randomized studies. Regional Anesthesia & Pain Medicine, v. 43, n. 5, p. 502-508, 2018.




DOI: https://doi.org/10.34119/bjhrv3n5-062

Refbacks

  • There are currently no refbacks.