부산대학교 도서관

Objective: Reducing the risk of post-dural puncture headache (PDPH) remains a clinical challenge. This meta-analysis aims at investigating the effects of prophylactic neuraxial morphine on risk and severity of PDPH. Methods: CENTRAL, EMBASE, and MEDLINE were searched for randomized controlled trials (RCTs) and non-RCTs that compared participants with or without neuraxial morphine prophylaxis against PDPH from inception till January 4, 2021. Results: Of the seven eligible studies involving 3,949 participants (RCT = 4, non-RCT= 3) published between 1992 and 2020, six focused on parturients receiving spinal anesthesia or undergoing epidural procedures with an unintentional dural puncture and one investigated women subjected to spinal or epidural anesthesia with an inadvertent dural puncture. Our results demonstrated no association between the use of neuraxial morphine and risks of PDPH [relative risk (RR) = 0.76; 95% confidence interval (CI): 0.54 - 1.07, 3,949 participants] and epidural blood patch requirement (RR = 0.86, 95% CI: 0.58-1.29, 3,949 participants) as well as headache severity (mean difference = -0.32, 95% CI: -1.52 to 0.87, 191 participants). Consistently, subgroup analysis (i.e., RCT vs. non-RCT) and sensitive analysis revealed similar findings. Besides, use of neuraxial morphine increased the risk of pruritis (RR = 8.5, 95% CI: 3-24.12, 132 participants). Conclusion: There was no evidence supporting the efficacy of prophylactic neuraxial morphine against post-dural puncture headache. Other pharmacological strategies for prophylaxis or headache alleviation should be initiated when dural puncture occurs especially in high-risk patients such as parturients.