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J Clin Anesth. 2015 May;27(3):201-6. doi: 10.1016/j.jclinane.2014.07.008. Epub 2014 Dec 4.

Chronic headache and backache are long-term sequelae of unintentional dural puncture in the obstetric population.

Author information

1
West Virginia University School of Medicine, Morgantown, WV, 26506.
2
Magee-Women's Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, 15213.
3
Duquesne University, Pittsburgh, PA, 15282.
4
Magee-Women's Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, 15213; West Virginia University School of Medicine, Morgantown, WV, 26506. Electronic address: vallejom@wvuhealthcare.com.

Abstract

INTRODUCTION:

Unintentional dural puncture (UDP) and postdural puncture headache (PDPH) occur during the course of epidural catheter placement for labor analgesia with a reported incidence of 1%-5%. After UDP with an epidural needle, 80%-86% of patients develop PDPH. Acute symptoms after UDP are well known. However, few studies have evaluated the long-term complications of UDP, which is important in assisting parturients in the decision-making informed consent process. We sought to elucidate the long-term (>6 weeks) sequelae of PDPH by examining parturients who had UDP (both recognized and unrecognized) associated with labor epidural analgesia.

METHODS:

Parturients with a documented UDP (n = 308) over a 5-year period were followed up for acute and long-term residual symptoms (lasting >6 weeks) and compared with a control group (no documented UDP, n = 50) in the same period. Specific symptoms included headache, backache, neck ache, auditory symptoms, and visual symptoms.

RESULTS:

In comparing parturients with a UDP with control group (no UDP), differences were noted in overall acute symptoms (75.9% vs 21.7%, P < .001), specifically headache (87.0% vs 8.7%, P < .001), backache (47.2% vs 19.6%, P = .002), neck ache (30.1% vs 2.2%, P < .001), auditory (13.8% vs 0%, P = .02), and visual symptoms (19.5% vs 0%, P = .002). Differences were also noted in comparing chronic symptoms (26.5% vs 10.9%, P = .04) and specifically with respect to chronic headache (34.9% vs 2.2%, P < .001), backache (58.1% vs 4.4%, P < .001), and neck ache (14.0% vs 0%, P = .02). No differences were noted between groups in comparing chronic auditory and visual symptoms.

CONCLUSION:

Chronic headache and backache sequelae persist in the obstetrical population after UDP. When parturients are considering labor epidural analgesia, long-term sequelae should be discussed in the informed consent decision-making process.

KEYWORDS:

Dural puncture; Epidural; Long-term complications; Sequelae

PMID:
25483233
DOI:
10.1016/j.jclinane.2014.07.008
[Indexed for MEDLINE]

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