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THE INCIDENCE, RISK FACTORS, AND OUTCOME OF POST-DURAL PUNCTURE HEADACHE AFTER DURAL PUNCTURE WITH A 17G EPIDURAL NEEDLE
Abstract Number: S-26
Abstract Type: Original Research
INTRODUCTION: Post-dural puncture headache (PDPH) is the most common complication of epidural placement and can be associated with significant maternal morbidity. Despite a considerable body of research, most studies are heterogeneous and therefore less is known about the factors associated with PDPH after unintentional dural puncture specifically with a 17G epidural needle.
METHODS: To determine the incidence and risk factors of PDPH after 17G dural puncture, we identified a retrospective cohort of 147 patients who received care between January 2009 and May 2011 at two large, tertiary referral centers. Medical Record Review was used to obtain patient demographics, prior medical history including history of headaches, and mode of delivery.
RESULTS: The incidence of PDPH after frank wet tap with a 17G epidural needle was found to be 68%. The median time to presentation with headache was 0.5 days. Blood patch was performed in 62 (42%) patients; 18 (12%) required more than one blood patch. The mean follow-up time for patients was 6 days; at final follow-up 46 (31%) reported continued headache.
Univariate analysis between the incidence of PDPH and age, race, or prior history of headache showed no significant relationship in our cohort. BMI was not associated with the development of PDPH in our sample (P = 0.80, Wilcoxon rank sum test). Lack of second stage pushing and cesarean delivery were protective against PDPH (P < 0.01, Fisher’s exact test for each variable).
CONCLUSION: Our findings suggest that cesarean delivery and lack of second stage pushing are protective against PDPH after dural puncture with a 17G needle. Since these two factors are collinear, it is not possible to assess the individual contribution of each factor. Comparatively lower mobility and more liberal use of analgesics in women after cesarean delivery and an increase in CSF leak associated with pushing may contribute to the observed effect. In contrast to other recent studies, increased BMI was not associated with the development of PDPH; it is possible that with a large dural puncture increased BMI does not stem CSF leak and provide protection. Further studies are needed to identify the subset of patients most at risk for PDPH and determine whether early interventions in these high-risk patients can prevent the development of PDPH.