Incidence and management of accidental dural puncture and postdural puncture headache in parturients: Retrospective database study.

BACKGROUND

Postdural puncture headache (PDPH) is a common complication of neuraxial block resulting from either intentional dural puncture (IDP) or accidental dural puncture (ADP).

OBJECTIVES

The primary objective was to estimate the rate of PDPH and ADP following introduction of a real-time documentation system in April 2018. Secondary objectives included examining the use of epidural blood patch (EBP) and investigating risk factors associated with ADP and PDPH.

DESIGN

Retrospective cohort study.

SETTING

Secondary care at a tertiary hospital from January 2017 to April 2022.

PATIENTS: Three hundred and eleven adult parturients after neuraxial block, with PDPH or a reported ADP, were identified during the procedure or postpartum.

INTERVENTIONS: Implementation of a real-time documentation system in April 2018 to improve PDPH and ADP documentation.

MAIN OUTCOME MEASURES: Rates of PDPH and ADP, performance of epidural blood patch, and risk factors associated with PDPH and ADP.

RESULTS

The overall rate of PDPH was 0.4% (164/39888), 95% confidence intervals (CI) 0.0036 to 0.0049, and the rate of ADP was 0.9% (284/31635), 95% CI 0.0078 to 0.0099. During the real-time documentation period, the rates were 0.44% (157/35376), 95% CI 0.0038 to 0.0052, and 0.99% (279/28121), 95% CI 0.0088 to 0.0111, for PDPH and ADP respectively. Thirty-two (10.3%) cases had IDP, and 279 (89.7%) had ADP. Among 279 ADP cases, 76.3% were identified during the procedure, 10.4% were suspected and 13.3% were identified postpartum. Cases of ADP identified postpartum had more emergency room visits (19%). Epidural blood patch was administered in 72% of PDPH cases, with a high first-time success rate (89.5%); Eleven women received EBP after IDP.

CONCLUSIONS

Postdural puncture headache remains a significant concern. In our cohort, 13.3% of ADP cases were detected postpartum, posing an increased challenge and underscoring the critical importance of follow-up care. We confirm that epidural blood patch may be required following any neuraxial block.