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Chronic Headache and Back Pain after Unintentional Dural Puncture: A Prospective Cohort Study
Abstract Number: F5B-6
Abstract Type: Original Research
Introduction: Two previous retrospective studies have found increased incidence of chronic headache (HA) in parturients who suffer unintentional dural puncture (UDP) with a Tuohy needle (1,2). No prospective studies using validated instruments have examined this phenomenon.
Methods: This IRB-approved, prospective study enrolled parturients with UDP at the same time as 4 controls who delivered by the same route with uncomplicated neuraxial procedures. The primary outcome was incidence of persistent HA at 2 months post-partum. Secondary outcome measures were incidence, severity, frequency, and type (by ICDH-3 criteria) of HA at 2 months and at 6-12 months, adjusted for HA history. Back pain incidence, severity, MIDAS disability score, requirement for epidural blood patch (EBP), and breastfeeding success were also evaluated.
Results: 99 patients were enrolled (22 UDP, 77 control). There was no difference in age, height, mode of delivery, or pre-pregnancy incidence of HA or back pain. Body mass index (31 +/- 4 UDP, 28 +/- 3 control; p=0.05), and Spanish as a primary language (45% UDP, 10% control; p<0.001) differed between groups. There was 21% loss to follow up at 2 months and 32% loss to follow up at 6-12 months, with no significant difference between groups.
77 % of women with UDP reported HA during hospitalization compared to 14% of controls (OR=19, p<0.001). All women with UDP reported a postural component to HA as compared to 20% of controls. 50% of women with UDP and 0 controls received an EBP. The incidence of HA at 2 months postpartum in the UDP group was significantly higher than in controls (74% vs. 38%, OR=4.5, p=0.008). At 6-12 months, 56% of the UDP group and 24% of the controls reported HA (OR=4.2, p=0.03). Pain severity was also significantly greater at all time points in the UDP group (Figures B and C). At 6-12 months, back pain incidence was also significantly higher in patients with UDP than controls (44% vs. 18%, OR 3.5, P=0.04).
Conclusion: Postpartum incidence of HA and back pain is high in both study cohorts. However, women with UDP experience markedly higher incidence, severity, and duration of HA. This is the first prospective study to confirm the concerning finding of chronic HA and back pain as long term sequelae of UDP. Larger studies are needed determine whether interventions such as EBP can change these sequelae.
1) Anesth Analg. 2012;115(1):124-32
2) J Clin Anesth. 2015;27(3):201-6