Chronic pain in parturients with an accidental dural puncture: A case‐controlled prospective observational study

Abstract

Background: We set out to examine incidence of chronic headache and back pain in women with PDPH after accidental dural puncture during labor.Methods: Chronic headache, backache, and disability were assessed 18-24 months postpartum. Women with PDPH treated with epidural blood patch (PDPH-EBP) were identified and matched with women who had a PDPH without epidural blood patch (PDPH-no EBP), with women with uncomplicated epidural analgesia and with women without epidural analgesia. Our primary outcome was incidence of chronic headache and backache. Secondary outcome was the effect of epidural blood patch on chronic pain development. We used Chi-square or Fisher's exact test to calculate odds ratios.Results: There was no statistically significant difference in demographic characteristics between groups. In the no epidural group, no women reported chronic headache and 2/116 (1.7%) reported chronic backache. In the uncomplicated epidural group, no women reported chronic headache and 7/116 (6.0%) reported chronic backache.In the PDPH-no EBP group, 9/56 (16.1%) women reported chronic headache and 10/56 (17.9%) reported chronic backache. In the PDPH-EBP group, 12/59 (20.3%) had chronic headache and 14/59 (23.7%) had chronic backache. No women in the no epidural or uncomplicated epidural group reported disability (chronic pain score of 3 or 4). High disability was reported by 8.9% of women in the PDPH-no EBP group and by 8.4% in the PDPH-EBP group. Conclusion:Women with PDPH had a high incidence of chronic headache, back pain, and disability. We did not find a statistically significant difference in chronic pain development between conservatively treated and EBP-treated patients. Editorial CommentThere is limited evidence concerning long-term effects of post-dural puncture headaches in the obstetric patient. In this prospective, observational case-control study, PDPH was associated with chronic backache and headache disability, but not to choice of headache treatment, conservative versus epidural blood patch. Parturients suffering from PDPH may need long-term follow up.How to cite this article: Binyamin Y, Heesen P, Orbach-Zinger S, et al. Chronic pain in parturients with an accidental dural puncture: A case-controlled prospective observational study.

Long-term Complications of Unintentional Dural Puncture During Labor Epidural Analgesia: A Case-Control Study

“…Similar to what was observed by Ranganathan et al (7) and Binyamin et al (25) , we did not observe a difference in the incidence of chronic symptoms in women who had an epidural blood patch compared to those who did not. Webb et al (5) , however, reported a lower incidence of both headache and backache in women who received EBP as compared to those who did not.…”

“…The management of PDPH in our cohort may have been more conservative than that reported in similar studies. We performed EBP in 41.7% of women who had PDPH, whereas Binyamin et al (25) , Webb et al (5) and Ranganathan et al (7) reported 51.3%, 62.5% and 53.4% respectively.…”

“…MacArthur et al (16) looked at the onset of new headache, migraine or neck pain within three months after childbirth and lasting over six weeks; they reported one or more of these symptoms in 23% of women sustaining UDP in their study. A more recent prospective case-control study by Binyamin et al (25) , where women with previous symptoms were excluded, noted the presence of chronic headache and chronic back pain in 16.1% and 17.9% of women respectively, amongst those who sustained UDP and did not receive EBP.…”

Flouroscopic versus conventional epidural blood patch in obstetrics: A retrospective cohort study

“…Accidental dural puncture is the most common complication in obstetric anesthesia, occurring in 0.5%‐1% of all labor epidurals 1 and resulting in a postdural puncture headache (PDPH) in 60%‐70% of these parturients 2 . PDPH is a debilitating condition that can lead to long‐term chronic headache and backache and serious neurological sequelae 3‐6 …”

Anesthesiologists’ perspectives on why dural punctures occur: a multicenter international survey

“…Accidental dural puncture (ADP) is a serious complication of obstetric anesthesia 1 2. Although several studies have identified specific risk factors, there remains a need for modifiable etiologies3 4 There has been growing interest in root cause analysis, an exploration of key system-level factors as contributors to the occurrence of accidents 3.…”