title: Nine-year audit of post-dural puncture headache in a tertiary obstetric hospital in Singapore.
abstract: BACKGROUND
  The KK Women's and Children's Hospital is a tertiary obstetric unit with approximately 11000 deliveries per year. Epidural analgesia is used in about 40% of laboring women. We reviewed the incidence and management of post-dural puncture headache over a nine-year period.
  
  
  METHODS
  A retrospective audit of labor epidural analgesia database records from 1 June 2005 to 31 May 2014 was conducted, identifying an "event" as an accidental dural puncture, an inadvertent intrathecal catheter insertion and/or development of a post-dural puncture headache.
  
  
  RESULTS
  A total of 43434 epidural records were reviewed. Sixty-three events were identified (an incidence of 0.15%). Women had median age of 30years and median body mass index of 27.6kg/m2; 69.8% (44/63) delivered vaginally. Procedures performed by less experienced anesthesiologists and those performed outside office hours were associated with a higher incidence of accidental dural puncture. An intrathecal catheter was inserted in 52 of 58 women (89.7%). Headache developed in 24 of 38 (63.1%) women in whom there was a witnessed accidental dural puncture. Most women who developed post-dural puncture headache presented during the primary admission (36/39; 92.3%). Paracetamol and non-steroidal anti-inflammatory drugs were the most commonly prescribed medications. Six women (9.5%) received an epidural blood patch which led to resolution of headache.
  
  
  CONCLUSIONS
  A retrospective audit over a nine-year period at a tertiary teaching hospital found the overall incidence of post-dural puncture headache and associated events to be 0.15%, with a decreasing trend coinciding with improvement in the teaching and supervision of trainees in labor epidural procedures.
authors.affiliation: Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore. Electronic address: claudia.tien.j.c@singhealth.com.sg.
authors.forename: J C
authors.initials: JC
authors.lastname: Tien
authors.affiliation: Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore.
authors.forename: M J
authors.initials: MJ
authors.lastname: Lim
authors.affiliation: Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore.
authors.forename: W L
authors.initials: WL
authors.lastname: Leong
authors.affiliation: Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore.
authors.forename: E
authors.initials: E
authors.lastname: Lew
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D017217:Blood Patch, Epidural / Q000706:statistics & numerical data; D054869:Clinical Audit / Q000706:statistics & numerical data*; D002983:Clinical Competence / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D051299:Post-Dural Puncture Headache / Q000453:epidemiology* / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen
keywords: Epidural blood patch; Epidural training; Labor analgesia; Obstetrics; Post-dural puncture headache