DOI: 10.4103/joacc.joacc_99_25 ISSN: 2249-4472

Post-dual Puncture Headache Following Accidental Dural Puncture during Labor Epidural Analgesia: Five-Year Retrospective Study in a Tertiary Hospital in the United Arab Emirates

Aaesha H. Alkhateri, Santosh Patel, Ahmed Ridha, Fatima Nabi, Ashraf Khasati, Radeya Alkatheeri, Shamma Alnaqbi, Lina AlSheikh, Farah Maree
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Abstract

Background:

Quality of labor epidural analgesia (LEA) involves management of its associated complication of post-dural puncture headache (PDPH). We aimed to review labor epidural rates, the incidence of PDPH, and its management.

Methods:

In this retrospective study, we collected data on women who experienced PDPH from March 2019 to April 2024. The data was obtained from the electronic health record and labor analgesia procedural database. We used the International Classification of Headache Disorders (ICHD-3) criteria to define PDPH. Our data extraction process included gathering information on demographics (age, parity, body mass index (BMI)), PDPH characteristics, and management data.

Results:

Over the five-year study period, 1,365 parturients received epidural analgesia for labor pain, with an overall LEA rate of 8.5%. The PDPH incidence was 1.34%. We did not find any significant association between maternal age, BMI, parity, and PDPH ( P values 0.53, 0.772, and 0.809, respectively). Multiple attempts were significantly associated with PDPH incidence ( P < 0.001; 95% confidence interval (CI): 1.150–3.882). The headache onset occurred within 24 h in 58.8% of cases, with a mean onset of 1.7 ± 0.8 days and a median of 1 day. About 76.5% patients were treated conservatively. An epidural blood patch was administered in 17.6% of cases to manage PDPH. There was no readmission due to PDPH.

Conclusion:

LEA rates at our institution are lower than those in developed Western countries. Multiple attempts were associated with PDPH, but its incidence rate is within acceptable international standards.

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