Incidence and management of accidental dural puncture and postdural puncture headache in parturients: Retrospective database study

Stav Cohen; Chaim Greenberger; Boris Aptekman; Victor Rabkin; Carolyn F Weiniger

doi:10.1097/EJA.0000000000002130

Incidence and management of accidental dural puncture and postdural puncture headache in parturients: Retrospective database study

Eur J Anaesthesiol. 2025 Feb 12. doi: 10.1097/EJA.0000000000002130. Online ahead of print.

Authors

Stav Cohen¹, Chaim Greenberger, Boris Aptekman, Victor Rabkin, Carolyn F Weiniger

Affiliation

¹ From the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (SC), Department of Anaesthesia, Intensive Care and Pain, Tel Aviv Sourasky Medical Center, affiliated with the Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel (CG, BA, VR, CFW).

PMID: 39935247
DOI: 10.1097/EJA.0000000000002130

Abstract

Background: Postdural puncture headache (PDPH) is a common complication of neuraxial block resulting from either intentional dural puncture (IDP) or accidental dural puncture (ADP).

Objectives: The primary objective was to estimate the rate of PDPH and ADP following introduction of a real-time documentation system in April 2018. Secondary objectives included examining the use of epidural blood patch (EBP) and investigating risk factors associated with ADP and PDPH.

Design: Retrospective cohort study.

Setting: Secondary care at a tertiary hospital from January 2017 to April 2022.

Patients: Three hundred and eleven adult parturients after neuraxial block, with PDPH or a reported ADP, were identified during the procedure or postpartum.

Interventions: Implementation of a real-time documentation system in April 2018 to improve PDPH and ADP documentation.

Main outcome measures: Rates of PDPH and ADP, performance of epidural blood patch, and risk factors associated with PDPH and ADP.

Results: The overall rate of PDPH was 0.4% (164/39888), 95% confidence intervals (CI) 0.0036 to 0.0049, and the rate of ADP was 0.9% (284/31635), 95% CI 0.0078 to 0.0099. During the real-time documentation period, the rates were 0.44% (157/35376), 95% CI 0.0038 to 0.0052, and 0.99% (279/28121), 95% CI 0.0088 to 0.0111, for PDPH and ADP respectively. Thirty-two (10.3%) cases had IDP, and 279 (89.7%) had ADP. Among 279 ADP cases, 76.3% were identified during the procedure, 10.4% suspected and 13.3% identified postpartum. Cases of ADP identified postpartum had more emergency room visits (19%). Epidural blood patch (EBP) was administered in 72% of PDPH cases, with a high first-time success rate (89.5%); 11 women received epidural blood patch after IDP.

Conclusions: Postdural puncture headache remains a significant concern. In our cohort, 13.3% of ADP cases were detected postpartum, posing an increased challenge and underscoring the critical importance of follow-up care. We confirm that epidural blood patch may be required following any neuraxial block.

Trial registration: Not applicable.