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Identifying the True Incidence of PDPH after Accidental Dural Puncture in the Local Population
Abstract Number: F-19
Abstract Type: Original Research
Accidental dural punctures (ADPs) during neuraxial techniques are infrequent – 0.16-1.3% incidence in non-obese and up to 4% in obese individuals— although when they occur the incidence of subsequent Post-dural puncture headache (PDPH) is estimated at 50-60%1,2. We have anecdotally observed a lower incidence of PDPH in our obese patients. This study examines the ADPs in the local patient population with the aim of determining whether an association exists between BMI and PDPH incidence.
We conducted a retrospective cohort study, searching our electronic medical records for patients that incurred an ADP during neuraxial techniques. All patients were parturients. All ADPs occurred with an 18g Tuohy needle, and the primary outcome was the PDPH incidence.
Patients with ADPs (n=38) were assigned to either the obese group (BMI ≥ 30 kg/m^2, n=21) or the non-obese group (BMI <30 kg/m^2, n=17). The populations were compared with a chi-squared test with a P <0.05 considered significant. Total incidence of PDPH was 39.47% (15/38), with 9.5% of obese and 76.47% of non-obese patients developing a PDPH. Compared to the 50-60% rate of PDPH cited in literature, the rate demonstrated in our obese group was significantly different (P<0.001). No significant difference was observed between the non-obese group and the expected rate (P>0.05).
Our results are consistent with other studies that suggest an inverse relationship between BMI and PDPH incidence. Peralta et al. used 17g Tuohy needles and reported a 39% incidence of PDPH in their high BMI group. The PDPH rate in our high BMI group was 9.5%, but with 18g Tuohy needles. Both studies found a lower incidence of PDPH in their respective high BMI groups as compared to the lower BMI groups. In the obese patients the purported protective mechanisms may be due to changes in the epidural/intrathecal spaces, with increased intra-abdominal and epidural pressures that ultimately reduce the CSF loss after ADP1,2. It is also possible that the magnitude of these protective mechanisms increases along with BMI, as 0/7 patients with a BMI ≥40 kg/m^2 developed a PDPH.
1. Miu M, et al. The relationship between body mass index and post-dural puncture headache in obstetric patients. Int J Obstet Anesth. 2014;23
2. Peralta F, et al. The Relationship of body mass index with the incidence of postdural puncture headache in parturients. Anes and Analg 2015;121