title: Chronic headache and backache are long-term sequelae of unintentional dural puncture in the obstetric population.
abstract: BACKGROUND
  Unintentional dural puncture (UDP) and postdural puncture headache (PDPH) occur during the course of epidural catheter placement for labor analgesia with a reported incidence of 1%-5%. After UDP with an epidural needle, 80%-86% of patients develop PDPH. Acute symptoms after UDP are well known. However, few studies have evaluated the long-term complications of UDP, which is important in assisting parturients in the decision-making informed consent process. We sought to elucidate the long-term (>6 weeks) sequelae of PDPH by examining parturients who had UDP (both recognized and unrecognized) associated with labor epidural analgesia.
  
  
  METHODS
  Parturients with a documented UDP (n = 308) over a 5-year period were followed up for acute and long-term residual symptoms (lasting >6 weeks) and compared with a control group (no documented UDP, n = 50) in the same period. Specific symptoms included headache, backache, neck ache, auditory symptoms, and visual symptoms.
  
  
  RESULTS
  In comparing parturients with a UDP with control group (no UDP), differences were noted in overall acute symptoms (75.9% vs 21.7%, P < .001), specifically headache (87.0% vs 8.7%, P < .001), backache (47.2% vs 19.6%, P = .002), neck ache (30.1% vs 2.2%, P < .001), auditory (13.8% vs 0%, P = .02), and visual symptoms (19.5% vs 0%, P = .002). Differences were also noted in comparing chronic symptoms (26.5% vs 10.9%, P = .04) and specifically with respect to chronic headache (34.9% vs 2.2%, P < .001), backache (58.1% vs 4.4%, P < .001), and neck ache (14.0% vs 0%, P = .02). No differences were noted between groups in comparing chronic auditory and visual symptoms.
  
  
  CONCLUSIONS
  Chronic headache and backache sequelae persist in the obstetrical population after UDP. When parturients are considering labor epidural analgesia, long-term sequelae should be discussed in the informed consent decision-making process.
authors.affiliation: West Virginia University School of Medicine, Morgantown, WV, 26506.
authors.forename: Pavithra
authors.initials: P
authors.lastname: Ranganathan
authors.affiliation: Magee-Women's Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, 15213.
authors.forename: Chaim
authors.initials: C
authors.lastname: Golfeiz
authors.affiliation: Duquesne University, Pittsburgh, PA, 15282.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Phelps
authors.affiliation: Magee-Women's Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, 15213.
authors.forename: Sukhdip
authors.initials: S
authors.lastname: Singh
authors.affiliation: Magee-Women's Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, 15213.
authors.forename: Helen
authors.initials: H
authors.lastname: Shnol
authors.affiliation: Magee-Women's Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, 15213.
authors.forename: Nicole
authors.initials: N
authors.lastname: Paul
authors.affiliation: West Virginia University School of Medicine, Morgantown, WV, 26506.
authors.forename: Ahmed F
authors.initials: AF
authors.lastname: Attaallah
authors.affiliation: Magee-Women's Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, 15213; West Virginia University School of Medicine, Morgantown, WV, 26506. Electronic address: vallejom@wvuhealthcare.com.
authors.forename: Manuel C
authors.initials: MC
authors.lastname: Vallejo
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects; D000773:Anesthesia, Obstetrical / Q000009:adverse effects; D001416:Back Pain / Q000209:etiology*; D005260:Female; D020773:Headache Disorders / Q000209:etiology*; D006801:Humans; D051299:Post-Dural Puncture Headache / Q000150:complications*; D011247:Pregnancy
keywords: Dural puncture; Epidural; Long-term complications; Sequelae