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Consensus Practice Guidelines on Postdural Puncture Headache From a Multisociety, International Working Group: A
Vishal Uppal1, Robin Russell2, Rakesh Sondekoppam3
1Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Halifax, Nova Scotia, Canada.
JAMA Network Open
|August 15, 2023
Summary
Postdural puncture headache (PDPH) guidelines are now available to help clinicians prevent, diagnose, and manage this condition. These evidence-based recommendations address the lack of uniform treatment approaches for PDPH.
Area of Science:
- Anesthesiology and Pain Management
- Neurology
- Evidence-Based Medicine
Background:
- Postdural puncture headache (PDPH) is a common complication following neuraxial procedures, yet evidence-based guidance for its management is lacking.
- Unintentional or intentional dural puncture during procedures like spinal anesthesia can lead to PDPH.
- Existing clinical practice lacks uniform approaches for PDPH prevention, diagnosis, and treatment.
Framework:
- Developed practice guidelines through a multidisciplinary consensus approach involving 6 professional societies.
- Utilized a modified Delphi method with 2 rounds of anonymous voting by a 21-member team.
- Generated 47 recommendations for PDPH risk factors, prevention, diagnosis, and management, with evidence grading.
Implementation:
- Conducted a comprehensive literature search up to March 2022, including clinical trials and systematic reviews.
- Each review group submitted narrative reviews and recommendations rated by evidence strength.
- Achieved 90% to 100% consensus on most recommendations, identifying areas of moderate to low evidence certainty.
Implications:
- Provides a structured framework for clinicians to assess PDPH risk, diagnose, and manage patients systematically.
- Addresses the current void in evidence-based guidance for PDPH.
- Highlights opportunities for future research to strengthen the evidence base for PDPH management.
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