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PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies

[Les céphalées post-ponction durale sont une complication courante du bloc neuraxial chez les parturientes : une méta-analyse d’études obstétricales]

Peter T. Choi, MD FRCPC^*,, Saramin E. Galinski, MD^*, Lawrence Takeuchi, MD FRCPC^*, Stefan Lucas, MD, Carmen Tamayo, MD MPH^¶ and Alejandro R. Jadad, MD DPhil FRCPC

^* From the Departments of Anesthesia, and
Clinical Epidemiology Biostatistics, St. Joseph’s Healthcare and McMaster University, Hamilton, Ontario;
the Departments of Anesthesia and Health Policy, Management, and Evaluation, University Health Network, University of Toronto, Toronto, Ontario, Canada;
the Department of Anesthesia, University of Rochester, Rochester, New York, USA; and
^* Foresight Links Corporation, London, Ontario, Canada.

Address correspondence to: Dr. Peter T. Choi, Department of Anesthesia, McMaster University, 1200 Main Street West, Room HSC-2U5, Hamilton, Ontario L8N 3Z5, Canada. E-mail: choip{at}mcmaster.ca

Purpose: Postdural puncture headache (PDPH) is an iatrogenic complication of neuraxial blockade. We systematically reviewed the literature on parturients to determine the frequency, onset, and duration of PDPH.

Methods: Citations on PDPH in the obstetrical population were identified by computerized searches, citation review, and hand searches of abstracts and conference proceedings. Citations were included if they contained extractable data on frequency, onset, or duration of PDPH. Using meta-analysis, we calculated pooled estimates of the frequency of accidental dural puncture for epidural needles and pooled estimates of the frequencies of PDPH for epidural and spinal needles.

Results: Parturients have approximately a 1.5% [95% confidence interval (CI) 1.5% to 1.5%) risk of accidental dural puncture with epidural insertion. Of these, approximately half (52.1%; 95% CI, 51.4% to 52.8%) will result in PDPH. The risk of PDPH from spinal needles diminishes with small diameter, atraumatic needles, but is still appreciable (Whitacre 27-gauge needle 1.7%; 95% CI, 1.6% to 1.8%). PDPH occurs as early as one day and as late as seven days after dural puncture and lasts 12 hr to seven days.

Conclusion: PDPH is a common complication for parturients undergoing neuraxial blockade.

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