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

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% were suspected and 13.3% were identified postpartum. Cases of ADP identified postpartum had more emergency room visits (19%). Epidural blood patch was administered in 72% of PDPH cases, with a high first-time success rate (89.5%); Eleven women received EBP 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.