TY - JOUR
T1 - Incidence and management of accidental dural puncture and postdural puncture headache in parturients
AU - Cohen, Stav
AU - Greenberger, Chaim
AU - Aptekman, Boris
AU - Rabkin, Victor
AU - Weiniger, Carolyn F.
N1 - Publisher Copyright:
Copyright ß 2025 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.
PY - 2025/6/1
Y1 - 2025/6/1
N2 - 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.
AB - 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.
UR - https://www.scopus.com/pages/publications/105001414600
U2 - 10.1097/EJA.0000000000002130
DO - 10.1097/EJA.0000000000002130
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C2 - 39935247
AN - SCOPUS:105001414600
SN - 0265-0215
VL - 42
SP - 492
EP - 499
JO - European Journal of Anaesthesiology
JF - European Journal of Anaesthesiology
IS - 6
ER -