title: Impact of obesity on post-dural puncture headache.
abstract: BACKGROUND
  Previous studies have suggested an inverse relationship between obesity and development of post-dural puncture headache following spinal anesthesia. However, few have investigated the relationship between obesity and headaches after accidental dural puncture with an epidural needle. This study explored whether obesity has any association with headaches following an accidental dural puncture.
  
  
  METHODS
  Records of patients who received epidural analgesia for labor and vaginal delivery between January 2011 and June 2015 were reviewed. Body mass index, American Society of Anesthesiologists Physical Status and age were analyzed. Chi-squared analysis was performed to determine the relationship between the incidence and severity of post-dural puncture headaches and body mass index.
  
  
  RESULTS
  A total of 17497 epidurals were placed for vaginal deliveries. Of these, 164 patients met our criteria for accidental dural puncture, of whom 51.2% developed post-dural puncture headaches. Of patients who developed a post-dural puncture headache 35.7% required an epidural blood patch. Data analysis showed no significant relationship between body mass index and incidence of post-dural puncture headaches regardless of body mass index classification (P>0.05). There was no association between body mass index and the intensity of post-dural puncture headache (P=0.29).
  
  
  CONCLUSIONS
  Patients with a high body mass index do not appear to be protected from experiencing a post-dural puncture headache after an accidental dural puncture during placement of labor epidural analgesia. Additionally, the intensity of post-dural puncture headache does not vary with body mass index.
authors.affiliation: Department of Anesthesiology, Montefiore Medical Center, New York, NY, USA. Electronic address: jsong@montefiore.org.
authors.forename: J
authors.initials: J
authors.lastname: Song
authors.affiliation: Department of Anesthesiology, Montefiore Medical Center, New York, NY, USA.
authors.forename: T
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: A
authors.initials: A
authors.lastname: Choy
authors.affiliation: Department of Anesthesiology, Montefiore Medical Center, New York, NY, USA.
authors.forename: A
authors.initials: A
authors.lastname: Penaco
authors.affiliation: Department of Anesthesiology, Montefiore Medical Center, New York, NY, USA.
authors.forename: V
authors.initials: V
authors.lastname: Joseph
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical; D000767:Anesthesia, Epidural / Q000009:adverse effects; D000773:Anesthesia, Obstetrical / Q000009:adverse effects; D017217:Blood Patch, Epidural; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D009765:Obesity / Q000150:complications*; D051299:Post-Dural Puncture Headache / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications; D012189:Retrospective Studies; D055815:Young Adult
keywords: Accidental dural puncture; Analgesia, epidural; Body mass index; Post-dural puncture headache