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


CONCLUSIONS
PDPH is a common complication for parturients undergoing neuraxial blockade.
Department of Anesthesia, St. Joseph's Healthcare and McMaster University, 1200 Main Street West, Room HSC-2U5, Hamilton, Ontario L8N 3Z5, Canada. choip@mcmaster.ca
Peter T
PT
Choi
Saramin E
SE
Galinski
Lawrence
L
Takeuchi
Stefan
S
Lucas
Carmen
C
Tamayo
Alejandro R
AR
Jadad
D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D005260:Female; D006261:Headache / Q000209:etiology*; D006801:Humans; D011247:Pregnancy