RT Journal Article SR Electronic T1 Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group JF Regional Anesthesia & Pain Medicine JO Reg Anesth Pain Med FD BMJ Publishing Group Ltd SP rapm-2023-104817 DO 10.1136/rapm-2023-104817 A1 Uppal, Vishal A1 Russell, Robin A1 Sondekoppam, Rakesh V A1 Ansari, Jessica A1 Baber, Zafeer A1 Chen, Yian A1 DelPizzo, Kathryn A1 Dirzu, Dan Sebastian A1 Kalagara, Hari A1 Kissoon, Narayan R A1 Kranz, Peter G A1 Leffert, Lisa A1 Lim, Grace A1 Lobo, Clara A1 Lucas, Dominique Nuala A1 Moka, Eleni A1 Rodriguez, Stephen E A1 Sehmbi, Herman A1 Vallejo, Manuel C A1 Volk, Thomas A1 Narouze, Samer YR 2023 UL http://rapm.bmj.com/content/early/2023/08/13/rapm-2023-104817.abstract AB Introduction Postdural puncture headache (PDPH) can follow unintentional dural puncture during epidural techniques or intentional dural puncture during neuraxial procedures such as a lumbar puncture or spinal anesthesia. Evidence-based guidance on the prevention, diagnosis or management of this condition is, however, currently lacking. This multisociety guidance aims to fill this void and provide practitioners with comprehensive information and patient-centric recommendations to prevent, diagnose and manage patients with PDPH.Methods Based on input from committee members and stakeholders, the committee cochairs developed 10 review questions deemed important for the prevention, diagnosis and management of PDPH. A literature search for each question was performed in MEDLINE (Ovid) on 2 March 2022. The results from each search were imported into separate Covidence projects for deduplication and screening, followed by data extraction. Additional relevant clinical trials, systematic reviews and research studies published through March 2022 were also considered for the development of guidelines and shared with contributors. Each group submitted a structured narrative review along with recommendations graded according to the US Preventative Services Task Force grading of evidence. The interim draft was shared electronically, with each collaborator requested to vote anonymously on each recommendation using two rounds of a modified Delphi approach.Results Based on contemporary evidence and consensus, the multidisciplinary panel generated 50 recommendations to provide guidance regarding risk factors, prevention, diagnosis and management of PDPH, along with their strength and certainty of evidence. After two rounds of voting, we achieved a high level of consensus for all statements and recommendations. Several recommendations had moderate-to-low certainty of evidence.Conclusions These clinical practice guidelines for PDPH provide a framework to improve identification, evaluation and delivery of evidence-based care by physicians performing neuraxial procedures to improve the quality of care and align with patients’ interests. Uncertainty remains regarding best practice for the majority of management approaches for PDPH due to the paucity of evidence. Additionally, opportunities for future research are identified.Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information.