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Incidence of Post Dural Puncture Headaches and Epidural Blood Patches following Neuraxial Anesthesia in a Private Practice Setting: Analysis of 8,562 Anesthetics in 2014
Abstract Number: T-19
Abstract Type: Original Research
According to the United States Department of Health and Human Services, 3.9 million births were registered in the United States in 2013. While percentages vary based on multiple factors, it is estimated that around 60% of vaginal deliveries and almost 95% of cesarean sections receive neuraxial anesthesia in the form of an epidural, spinal, or combined spinal epidural (CSE). Post dural puncture headache (PDPH) is a known complication of neuraxial anesthesia, and parturients are know to develop PDPH at a higher rate than their older counterparts. Most studies on the incidence of PDPH and epidural blood patches (EBP) have been completed at academic centers where the incidence of inadvertent dural puncture might be higher than in the private practice setting. We questioned if the incidence of inadvertent dural punctures, PDPH and EBP would be lower in an experienced private practice setting.
A review was performed on prospectively collected data from obstetric anesthesiologists at Sharp Mary Birch Hospital for Woman and Newborns for all neuraxial procedures on obstetrical patients in the year 2014. This included the type of neuraxial technique, type and size of needle used, inadvertent dural puncture, presence of PDPH and need for EBP.
A total of 8,562 neuraxial anesthetics were performed during 2014 out of a total of 9400 deliveries. Of these, 4,893 were combined spinal epidural and 937 were continuous lumbar epidurals during labor. The remainder, 2732, were spinal anesthetics for cesarean delivery. The obstetric anesthesiology service was consulted to evaluate 24 post anesthetic headaches, of which 22 were deemed to likely be PDPH (0.28%). The incidence of inadvertent dural puncture with large bore needles (17 or 18G) during epidural insertion was 11/5,830 (0.19%). Three of those 11 required an EBP (27%). A total of 2,732 single shot spinal anesthetics were performed.for cesarean delivery. Of these, 2 patients required an EBP (0.07%). There were five more EBP done. Four on patients after CSE where it was uncertain if there was a dural puncture from the larger needle, and one from a 24 g pencil point needle for a cerclage. All patients had full relief from headache after EBP and were able to be discharged from hospital. To our knowledge, after follow up telephone calls 1 week, 3 months and 6 months following EBP no patient required a second blood patch.
These numbers represent a lower incidence of inadvertent dural puncture, PDPH, need for EBP, and EBP success rates than those previously reported in the literature. The overall rate of EBP for all patients who received neuraxial analgesia/anesthesia in our hospital was 0.11%. It is likely these low numbers reflect the experience of the obstetrical anesthesiologists and the type of needles used.
Paech MJ et al. The volume of blood for epidural blood patch in obstetrics: a randomized, blinded clinical trial. Anesth Analg. 2011;113:126-33