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

• Main Author: Vaz Antunes, Maria
• Publication Date: 2016
• Other Authors: Moreira, Adriano, Sampaio, Catarina, Faria, Aida
• Format: Article
• Language: por; eng
• Source: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Download full: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/6815
• topic: Analgesia; Epidural; Anesthesia; Obstetrical; Blood Patch; Dura Mater; Post-Dural Puncture Headache.; Analgesia Epidural; Anestesia Obstétrica; Cefaleia Pós-Punção Dural; Dura-Máter; Placa de Sangue Epidural.

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.