Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety...

Area of Science:

• Anesthesiology and Pain Management
• Neurology
• Evidence-Based Medicine

Background:

• Postdural puncture headache (PDPH) is a complication of neuraxial procedures, yet evidence-based guidance is lacking.
• Unintentional or intentional dural puncture can lead to PDPH, impacting patient care.
• Existing clinical practice lacks comprehensive, patient-centric recommendations for PDPH.

Purpose of the Study:

• To develop evidence-based, multisociety clinical practice guidelines for PDPH.
• To provide practitioners with comprehensive information for PDPH prevention, diagnosis, and management.
• To establish patient-centric recommendations for improving care quality.

Main Methods:

• A literature search identified 10 key review questions on PDPH.
• Data extraction and narrative reviews were conducted using MEDLINE and additional studies.
• Recommendations were graded using the US Preventative Services Task Force system and refined via a modified Delphi approach.

Main Results:

• A multidisciplinary panel generated 50 recommendations for PDPH risk factors, prevention, diagnosis, and management.
• High consensus was achieved for all statements and recommendations after two rounds of anonymous voting.
• The certainty of evidence for several recommendations was rated as moderate-to-low.

Conclusions:

• These guidelines offer a framework for improving PDPH identification, evaluation, and evidence-based care.
• Physicians performing neuraxial procedures can use these guidelines to enhance patient care quality.
• Further research is needed to address the paucity of evidence for many PDPH management approaches.