Post-dural puncture headache in pregnant women: What have we learned?

The obstetric patient is at particular risk of dural puncture (and the subsequent headache) because of sex, young age, and the widespread application of regional anesthesia. The incidence of epidural needle-induced post-dural puncture headache (PDPH) in pregnant women following dural puncture with a large bore needle has been reported to range 76-85%. Although a few measures have been proposed to prevent PDPH (intrathecal injection of saline, insertion of the epidural catheter into the subarachnoid space through the dural hole, none have been shown to work with certainty to date. This article reviews the latest developments aimed at prevention and treatment of this debilitating condition.

[1]  A. Bier.  Versuche über Cocainisirung des Rückenmarkes , 1899, Deutsche Zeitschrift für Chirurgie.

[2]  Greensmith Je,et al.  Complications of regional anesthesia. , 2006 .

[3]  K. M. Kuczkowski.  The management of accidental dural puncture , 2006, Anaesthesia.

[4]  K. Kuczkowski.  Decreasing the incidence of post‐dural puncture headache: an update , 2005, Acta anaesthesiologica Scandinavica.

[5]  D. Turnbull,et al.  Post-dural puncture headache: pathogenesis, prevention and treatment. , 2003, British journal of anaesthesia.

[6]  K. Kuczkowski.  Post-dural puncture headache, intracranial air and obstetric anesthesia , 2003, Der Anaesthesist.

[7]  J. Benumof,et al.  Decrease in the incidence of post‐dural puncture headache: maintaining CSF volume , 2003, Acta anaesthesiologica Scandinavica.

[8]  J. Benumof,et al.  ONCE A POST‐DURAL PUNCTURE HEADACHE PATIENT, ALWAYS POST‐DURAL PUNCTURE HEADACHE PATIENT: P‐20 , 2002, Acta anaesthesiologica Belgica.

[9]  A. Jadad,et al.  Examining the evidence in anesthesia literature: a survey and evaluation of obstetrical postdural puncture headache reports , 2002, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[10]  S. Abram,et al.  The Injection of Intrathecal Normal Saline Reduces the Severity of Postdural Puncture Headache , 2000, Regional Anesthesia & Pain Medicine.

[11]  M. Gentili,et al.  Seven months' delay for epidural blood patch in post-dural puncture headache. , 1999, European journal of anaesthesiology.

[12]  M. Gielen,et al.  Seven months delay for epidural blood patch in post-dural puncture headache. , 1999, European Journal of Anaesthesiology.

[13]  H. Flaatten,et al.  Postural post‐dural puncture headache after spinal and epidural anaesthesia. A randomised, double‐blind study , 1998, Acta anaesthesiologica Scandinavica.

[14]  K. C. Dennehy,et al.  Intrathecal catheter insertion during labour reduces the risk of postdural puncture headache , 1998, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[15]  M. Richardson,et al.  Density of Human Cerebrospinal Fluid , 1996, Regional Anesthesia & Pain Medicine.

[16]  D. Amar,et al.  Decreased incidence of headache after accidental dural puncture in caesarean delivery patients receiving continuous postoperative intrathecal analgesia , 1994, Acta Anaesthesiologica Scandinavica.

[17]  T. Taivainen,et al.  Efficacy of epidural blood patch for postdural puncture headache , 1993, Acta anaesthesiologica Scandinavica.

[18]  B. Leighton,et al.  Continuous Spinal Anesthesia after Unintentional Dural Puncture in Parturients , 1990, Regional Anesthesia & Pain Medicine.

[19]  P. Goldiner,et al.  An Alternative Method for Management of Accidental Dural Puncture for Labor and Delivery , 1989, Anesthesiology.

[20]  D. Selander,et al.  Postdural puncture headache after continuous spinal anesthesia. , 1987, Anesthesia and analgesia.

[21]  T. Yaksh,et al.  Studies of the Pharmacology and Pathology of Intrathecally Administered 4‐Anilinopiperidine Analogues and Morphine in the Rat and Cat , 1986, Anesthesiology.

[22]  J. Chestnut,et al.  Continuous Spinal Anesthesia Case Review and Discussion , 1983, Regional Anesthesia & Pain Medicine.

[23]  P. Brownridge.  The Management of Headache following Accidental Dural Puncture in Obstetric Patients , 1983, Anaesthesia and intensive care.

[24]  T. Kallos,et al.  Continuous Spinal Anesthesia With Hypobaric Tetracaine for Hip Surgery in Lateral Decubitus , 1972, Anesthesia and analgesia.