Neuraxial Morphine after Unintentional Dural Puncture is Not Associated with Reduced Postdural Puncture Headache in Obstetric Patients
| Autor: | Grace Lim, Patricia L. Dalby, David L. Seng, Jonathan H. Waters, Molly E. Brinser, Gordon L. Mandell |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Punctures Tertiary care Article Cohort Studies Pregnancy Risk Factors Medicine Humans Headache pain Retrospective Studies Epidural blood patch Labor Obstetric Morphine business.industry Incidence (epidemiology) Significant difference Retrospective cohort study Delivery Obstetric Analgesia Epidural Analgesics Opioid Anesthesiology and Pain Medicine Anesthesia Referral center Analgesia Obstetrical Female Dura Mater Post-Dural Puncture Headache business medicine.drug |
| Popis: | Study objective To examine the relationship between neuraxial morphine exposure after unintentional dural puncture and the risk for postdural puncture headache in obstetric patients. Design Retrospective cohort study. Setting Obstetrical unit at a tertiary care referral center. Patients Parturients receiving labor epidural analgesia with recognized unintentional dural puncture. Interventions Cases in which neuraxial morphine was given for any reason were compared to cases in which it was not for the outcome of postdural puncture headache. Measurements Development of postdural puncture headache, headache severity, number of epidural blood patches, hospital length of stay. Main results Of the 80 cases that were included, 38 women received neuraxial morphine and 42 did not. There was no significant difference in the incidence of headache between the two morphine groups (Headache present: Morphine: 27/56 [48.2%], No morphine: 29/56 [51.8%]; Headache free: Morphine: 11/24 [45.8%], No morphine: 13/24 [54.2%], P = 0.84). There was no difference in the need for epidural blood patch (Morphine: 24/42 [57.1%], No morphine: 18/38 [47.4%], P = 0.50) and headache severity (mean headache pain score: Morphine: 7.9 ± 1.8 vs. No morphine: 7.3 ± 2.4, P = 0.58). Hospital length of stay was higher in the morphine group (4.4 ± 2.9 days vs. 3.0 ± 1.5 days respectively, P = 0.008). Using logistic regression, morphine did not affect headache risk after controlling for covariates (morphine vs. no morphine: adjusted OR 1.24 [0.75]; P = 0.72; pre-eclampsia vs. no pre-eclampsia: adjusted OR 0.56 [0.41], P = 0.42; cesarean vs. normal spontaneous vaginal delivery: adjusted OR 0.97 [0.67]; P = 0.96). Conclusion In cases of unintentional dural puncture, exposure to neuraxial morphine for any reason may not be protective against the risk of postdural puncture headache. Although an overall protective effect of neuraxial morphine was not observed in this study, its role in specific subsets of patients remains to be investigated. |
| Databáze: | OpenAIRE |
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