Zusammenfassung
Kopfschmerzen nach Durapunktion sind eine typische Nebenwirkung rückenmarknaher Analgesie verfahren und können zu erheblichen Einschränkungen im Alltag des Patienten führen. Mit dünnen, atraumatischen Nadeln und spezieller Punktionstechnik (z. B. Wiedereinführen des Mandrins) kann ein großer Teil der Kopfschmerzen nach Spinalanästhesien vermieden werden. Zu den wirksamen Maßnahmen, die nach einer akzidentellen Durapunktion das Risiko von postpunktionellem Kopfschmerz verringern, gehört die rückenmarknahe Applikation von Morphin. Steht nach Ausschluss wichtiger, potenziell lebensbedrohlicher Differenzialdiagnosen die Diagnose postpunktionelle Kopfschmerzen fest, sind die Gaben von Koffein oder Theophyllin und Nichtopioidanalgetika wirksam zur Linderung der Symptome. Traditionelle Maßnahmen wie prophylaktische Bettruhe und Hyperhydratation werden nicht mehr empfohlen. Wird eine Intervention notwendig, ist der epidurale Blut-Patch (EBP) mit einer hohen Erfolgsrate weiterhin die Methode der Wahl.
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Radke, K., Radke, O. (2013). Postpunktioneller Kopfschmerz. In: Weiterbildung Anästhesiologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-40715-4_15
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