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A ten-year retrospective study of post-dural puncture headache in 32,655 obstetric patients

  • Ana C. CostaEmail author
  • James R. Satalich
  • Ehab Al-Bizri
  • Shivam Shodhan
  • Jamie L. Romeiser
  • Rishimani Adsumelli
  • Ramon E. Abola
  • Ellen S. Steinberg
  • Elliott Bennett-Guerrero
Reports of Original Investigations
  • 304 Downloads

Abstract

Purpose

Accidental dural puncture and post-dural puncture headache are well-known complications of neuraxial anesthesia in parturients. The primary goal of this study was to identify the rate of post-dural puncture headache and epidural blood patch in all parturients who received a neuraxial anesthetic during a ten-year period at an academic tertiary-care medical centre. A secondary goal was to identify any delay in hospital discharge due to a post-dural puncture headache.

Methods

We conducted a retrospective analysis of all patients who received a neuraxial anesthetic on the labour and delivery unit at Stony Brook Medical Center from 1 January, 2006 to 31 December, 2015. Standardized neuraxial anesthesia equipment was used throughout this period. Chart reviews were conducted on all patients who received a neuraxial anesthetic and had an accidental dural puncture and/or developed a post-dural puncture headache.

Results

Of the 32,655 neuraxial anesthetics performed, 298 (0.9%) patients experienced a post- dural puncture headache. Analysis of all patients who developed a post-dural puncture headache showed that 150 (50.3%) patients received one or more epidural blood patches. Overall, 19 (0.06%) patients had a delay in hospital discharge due to a post-dural puncture headache.

Conclusions

We showed a relatively low incidence (< 1%) of post-dural puncture headache following neuraxial anesthesia in parturients at an academic tertiary-care medical centre. Patients that rated their post-dural puncture headache as very severe were more likely to undergo at least one epidural blood patch procedure. Post-dural puncture headache is a well-known complication of neuraxial anesthesia, and may lead to a delay in hospital discharge.

Une étude rétrospective de dix ans sur les céphalées post-ponction de la dure-mère auprès de 32 655 patientes obstétricales

Résumé

Objectif

La ponction accidentelle de la dure-mère et les céphalées post-ponction dure-mérienne (CPPD) sont des complications bien connues de l’anesthésie neuraxiale chez les parturientes. L’objectif premier de cette étude était d’identifier le taux de CPPD et de colmatages sanguins périduraux (couramment appelés epidural blood patch) chez toutes les parturientes ayant reçu une anesthésie neuraxiale au cours d’une période de dix ans dans un centre médical universitaire de soins tertiaires. Un objectif secondaire était d’identifier tout délai dans le congé de l’hôpital dû à des CPPD.

Méthode

Nous avons réalisé une analyse rétrospective de toutes les patientes ayant reçu une anesthésie neuraxiale à l’unité des naissances du Centre médical Stony Brook entre le 1er janvier 2006 et le 31 décembre 2015. De l’équipement standardisé pour l’anesthésie neuraxiale a été utilisé tout au long de cette période. Les dossiers médicaux de toutes les patientes ayant reçu une anesthésie neuraxiale et ayant subi une ponction dure-mérienne accidentelle et/ou ayant manifesté des CPPD ont été passés en revue.

Résultats

Sur les 32 655 anesthésies neuraxiales réalisées, 298 (0,9 %) patientes ont souffert de CPPD. L’analyse de toutes les patientes ayant manifesté des CPPD a montré que 150 (50,3 %) patientes ont reçu un ou plusieurs colmatages sanguins périduraux. Globalement, 19 (0,06 %) patientes ont vu leur congé de l’hôpital retardé en raison de CPPD.

Conclusion

Nous avons démontré une incidence relativement faible (< 1 %) de céphalées post-ponction dure-mérienne après une anesthésie neuraxiale chez les parturientes prises en charge dans un centre médical universitaire de soins tertiaires. Les patientes ayant évalué leur CPPD comme étant très sévère étaient plus susceptibles de subir au moins une intervention de colmatage sanguin péridural. Les céphalées post-ponction de la dure-mère sont une complication bien connue de l’anesthésie neuraxiale et peuvent entraîner un retard dans le congé de l’hôpital.

Notes

Support

James R. Satalich, B.S. was supported by a Foundation for Anesthesia Education and Research Medical Student Anesthesia Research Fellowship.

Declarations of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

Author contributions

Ana C. Costa designed and conducted the study, reviewed data and analyses, and drafted the manuscript. James R. Satalich, Ehab Al-Bizri, and Shivam Shodhan collected the data and critically reviewed the manuscript. Jamie L. Romeiser performed all statistical analyses and critically reviewed the manuscript. Rishimani Adsumelli critically reviewed the data and manuscript. Ramon E. Abola and Ellen S. Steinberg critically reviewed the data and manuscript. Elliot Bennett-Guerrero helped design the study and reviewed the data and manuscript.

Financial disclosures

None.

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Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  • Ana C. Costa
    • 1
    • 3
    Email author
  • James R. Satalich
    • 2
  • Ehab Al-Bizri
    • 1
  • Shivam Shodhan
    • 1
  • Jamie L. Romeiser
    • 1
  • Rishimani Adsumelli
    • 1
  • Ramon E. Abola
    • 1
  • Ellen S. Steinberg
    • 1
  • Elliott Bennett-Guerrero
    • 1
  1. 1.Department of AnesthesiologyStony Brook Medical CenterStony BrookUSA
  2. 2.Virginia Commonwealth University School of MedicineRichmondUSA
  3. 3.Department of AnesthesiologyStony Brook MedicineStony BrookUSA

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