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To determine the prevalence of headache following a transdural lumbar puncture and the risk factors involved.The method used was a prospective observation-based cohort study. Patients were recruited from the A and E Department, Neurology Service and Day Care Clinic. The following data were collected: physician's experience, number of punctures, variations in the plane, patient's posture, local anaesthetic, needle calibre and bevel, degrees of inclination, amount of liquid, fluid overload and whether or not rest is indicated after the puncture. After 48 hours, the appearance of headache (or not) was determined.The sample consisted of 59 patients, 31 (52.5%) of whom were males. Mean age: 47 years; 32 patients (54.2%) came from A and E, 18 (30.5%) from Neurology and 9 (15.3%) from the Day Care Clinic. Forty-one (69.5%) received the lumbar puncture in a lateral decubitus position and 7 (11.9%) in a seated position. All the needles were bevelled, 21 (35.6%) with a calibre of 20 and 38 (64.4%) of calibre 22. Eight patients (13.56%) were without repose and 18 (33.3%) had no fluid overload. Twenty-three (38.98%) had post-lumbar-puncture headache, 12 (52.2%) of them females, with a mean age of 38.3 ± 16.4 years. The median of the headache intensity was 2.6. The mean time of appearance was seven hours. There were no differences for any of the factors studied, except the observed tendency towards a higher incidence of headache at younger ages.Rates of post-lumbar-puncture headache in our series are high, and no differences were found in terms of the service where it was performed or experience. No influence was observed due to the amount of liquid extracted, the patient's position, the indication of repose or fluid overload.Yatrogenia tras la tecnica de puncion lumbar. Estudio de prevalencia de cefalea y factores asociados.Objetivo. Establecer la prevalencia existente de cefalea tras practicar una puncion lumbar transdural y los factores de riesgo. Pacientes y metodos. Estudio observacional prospectivo de cohortes. Se reclutaron pacientes del Servicio de Urgencias, del Servicio de Neurologia y del Hospital de Dia. Se recogio la experiencia del facultativo, el numero de punciones, la variacion de plano, la postura del paciente, el anestesico local, el calibre y bisel de la aguja, los grados de inclinacion, la cantidad de liquido, la sobrecarga de fluidoterapia y la indicacion o no de reposo tras la puncion. Tras 48 horas, se establecio la aparicion o no de cefalea. Resultados. Muestra de 59 pacientes, 31 (52,5%) de ellos hombres. Edad media: 47 años; 32 (54,2%) procedentes de Urgencias, 18 (30,5%) de Neurologia y 9 (15,3%) del Hospital de Dia. Hubo 41 (69,5%) en decubito lateral y 7 (11,9%) en sedestacion. Todos con agujas biseladas, 21 (35,6%) del calibre 20 y 38 (64,4%) del calibre 22. Sin reposo estuvieron 8 (13,56%) pacientes y 18 (33,3%) sin sobrecarga de fluidos. Veintitres (38,98%) con cefalea pospuncion lumbar, 12 (52,2%) mujeres, con una edad media de 38,3 ± 16,4 años. La mediana de intensidad de la cefalea fue de 2,6. El tiempo medio de aparicion fue de siete horas. Sin diferencias para ninguno de los factores estudiados, salvo la tendencia observada de mayor incidencia de cefalea a menor edad. Conclusiones. La cefalea pospuncion lumbar en nuestra serie es elevada, sin diferencias segun el servicio donde se practica o la experiencia. Tampoco influye la cantidad de liquido extraido, la posicion del paciente, la indicacion de reposo o la sobrecarga de fluidos. |
