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Canadian Journal of Anesthesia

, Volume 50, Issue 5, pp 460–469 | Cite as

PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies

  • Peter T. ChoiEmail author
  • Saramin E. Galinski
  • Lawrence Takeuchi
  • Stefan Lucas
  • Carmen Tamayo
  • Alejandro R. Jadad
Obstetrical and Pediatric Anesthesia

Abstract

Purpose

Postdural puncture headache (PDPH) is an iatrogenic complication of neuraxial blockade. We systematically reviewed the literature on parturients to determine the frequency onset, and duration of PDPH.

Methods

Citations on PDPH in the obstetrical population were identified by computerized searches, citation review, and hand searches of abstracts and conference proceedings. Citations were included if they contained extractable data on frequency, onset, or duration of PDPH. Using meta-analysis, we calculated pooled estimates of the frequency of accidental durai puncture for epidural needles and pooled estimates of the frequencies of PDPH for epidural and spinal needles.

Results

Parturients have approximately a 1.5% [95% confidence interval (CI) 1.5% to 1.5%) risk of accidental durai puncture with epidural insertion. Of these, approximately half (52.1%; 95% CI, 51.4% to 52.8%) will result in PDPH. The risk of PDPH from spinal needles diminishes with small diameter, atraumatic needles, but is still appreciable (Whitacre 27-gauge needle 1.7%; 95% CI, 1.6% to 1.8%). PDPH occurs as early as one day and as late as seven days after durai puncture and lasts 12 hrto seven days.

Conclusion

PDPH is a common complication for parturients undergoing neuraxial blockade.

Keywords

Spinal Needle CPPD Dural Puncture Obstetric Anesthesia External Cephalic Version 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Les céphalées post-ponction durale sont une complication courante du bloc neuraxial chez les parturientes: une méta-analyse d’études obstétricales

Résumé

Objectif

Les céphalées post-ponction durale (CPPD) sont une complication iatrogène du bloc neuraxial. Une revue systématique des publications sur les parturientes a permis de déterminer la fréquence, le délai d’installation et la durée des CPPD.

Méthode

Les citations sur les CPPD dans la population obstétricale ont été repérées par des recherches informatisées, la revue des références et des recherches manuelles de résumés et de comptes rendus de conférences. Les références retenues devaient comporter des données sur la fréquence, le délai d’installation et la durée des CPPD. Nous avons calculé, par méta-analyse, les estimations groupées de la fréquence de ponction durale accidentelle par aiguilles péridurales et celles de la fréquence de CPPD par aiguilles péridurales et rachidiennes.

Résultats

Chez les parturientes, le risque de subir une ponction durale accidentelle avec une aiguille péridurale est d’environ 1,5 % [intervalle de confiance de 95 % (IC) 1,5 % à 1,5 %]. Environ la moitié de ces ponctions (52,1 % ; IC de 95 %, 51,4 % à 52,8 %) va provoquer des CPPD. Le risque de CPPD avec les aiguilles rachidiennes diminue pour des aiguilles atraumatiques de petit diamètre, mais demeure appréciable (aiguille Whitacre 27 G 1,7 % ; IC de 95 %, 1,6% à 1,8 %). Les CPPD surviennent parfois aussi tôt qu’un jour, et aussi tard que sept jours, après la ponction durale et durent de 12 h à sept jours.

Conclusion

Les CPPD sont une complication courante chez les parturientes qui subissent un bloc neuraxial.

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Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

  • Peter T. Choi
    • 1
    • 2
    Email author
  • Saramin E. Galinski
    • 1
  • Lawrence Takeuchi
    • 1
  • Stefan Lucas
    • 4
  • Carmen Tamayo
    • 5
  • Alejandro R. Jadad
    • 3
  1. 1.Department of AnesthesiaSt. Joseph’s Healthcare and McMaster UniversityHamilton
  2. 2.Clinical Epidemiology and BiostatisticsSt. Joseph’s Healthcare and McMaster UniversityHamilton
  3. 3.Departments of Anesthesia and Health Policy, Management, and EvaluationUniversity Health Network, University of TorontoTorontoCanada
  4. 4.Department of AnesthesiaUniversity of RochesterRochesterUSA
  5. 5.Foresight Links CorporationLondonCanada

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