Accidental Dural Puncture and Post-dural Puncture Headache in the Obstetric Population: Eight Years of Experience

Authors

  • Maria Vaz Antunes Serviço de Anestesiologia. Centro Hospitalar de São João. Porto.
  • Adriano Moreira Serviço de Anestesiologia. Centro Hospitalar de São João. Porto.
  • Catarina Sampaio Serviço de Anestesiologia. Centro Hospitalar de São João. Porto.
  • Aida Faria Serviço de Anestesiologia. Centro Hospitalar de São João. Porto.

DOI:

https://doi.org/10.20344/amp.6815

Keywords:

Analgesia, Epidural, Anesthesia, Obstetrical, Blood Patch, Dura Mater, Post-Dural Puncture Headache.

Abstract

Introduction: Accidental dural puncture is an important complication of regional anesthesia and post-dural puncture headache remains a disable outcome in obstetric population. The aim of our study was to calculate the incidence of accidental puncture and post-puncture headache and evaluate its management among obstetric anesthesiologists.
Material and Methods: We conducted a retrospective audit, between January 2007 and December 2014. We reviewed the record sheets of patients who experienced either accidental puncture or post-puncture headache. We excluded the patients undergoing spinal block. We use the SPSS 22.0 for statistical analyses.
Results: We obtained 18497 neuro-axial blocks and 58 accidental dural punctures (0.3%). After detected puncture, in 71.4% epidural catheter was re-positioned and 21.4% had intra-thecal catheters. Forty-five (77.6%) developed headache and the prophylactic measures were established in 76.1%. Conservative treatment was performed in all patients. The epidural blood patch was performed in 32.8% with a 84.2% of success.
Discussion: The incidence of post-dural puncture headache is unrelated to the type of delivery or insertion of intrathecal catheter. The re-placement of the epidural catheter remains the main approach after puncture. The institution of prophylactic measures is a common practice, despite the low level of evidence. We performed epidural blood patch after failure of conservative treatment.
Conclusion: The incidence of accidental dural puncture and post-dural puncture headache was similar to the literature. Despite being a common complication, there remains lack of consensus on its approach.

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Published

2016-04-29

How to Cite

1.
Vaz Antunes M, Moreira A, Sampaio C, Faria A. Accidental Dural Puncture and Post-dural Puncture Headache in the Obstetric Population: Eight Years of Experience. Acta Med Port [Internet]. 2016 Apr. 29 [cited 2024 Mar. 28];29(4):268-74. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/6815

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Original