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. 1993 Apr 3;306(6882):883–885. doi: 10.1136/bmj.306.6882.883

Accidental dural puncture in obstetric patients and long term symptoms.

C MacArthur 1, M Lewis 1, E G Knox 1
PMCID: PMC1677341  PMID: 8490410

Abstract

OBJECTIVE--To examine the association between accidental dural puncture and long term headache and related symptoms. DESIGN--Postal questionnaire survey to elucidate new symptoms occurring after childbirth, and linking of these to data in obstetric and anaesthetic case notes. Women were surveyed between 13 months and nine years after delivery. SETTING--Birmingham Maternity Hospital. SUBJECTS--4700 women who had delivered their most recent baby under epidural anaesthesia, 74 of whom had suffered an accidental dural puncture. MAIN OUTCOME MEASURES--Frequencies of new headache or migraine or neck ache starting within three months after childbirth and lasting over six weeks. RESULTS--Among the 74 women who had had an accidental dural puncture there were 17 (23%) who reported one or more of the above symptoms. By comparison, among those who had had an epidural anaesthetic but no recorded puncture, only 329 (7.1%) reported these symptoms. The duration of the headache or migraine or neck ache in the dural tap group ranged from nine weeks to over eight years. Ten of these women reported still unresolved symptoms. CONCLUSIONS--Conclusions on causality were tentative. Most women would remember a dural tap, and this might influence their reporting of subsequent symptoms attributable to the event. In addition, detailed characterisation of the symptoms was not available. Nevertheless, the findings provide a clear indication of the need for further study of the possible long term sequelae of accidental dural puncture.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abouleish E. Epidural blood patch for the treatment of chronic post-lumbar-puncture cephalgia. Anesthesiology. 1978 Oct;49(4):291–292. doi: 10.1097/00000542-197810000-00016. [DOI] [PubMed] [Google Scholar]
  2. Brownridge P. A three-year survey of an obstetric epidural service with top-up doses administered by midwives. Anaesth Intensive Care. 1982 Nov;10(4):298–308. doi: 10.1177/0310057X8201000401. [DOI] [PubMed] [Google Scholar]
  3. Brownridge P. The management of headache following accidental dural puncture in obstetric patients. Anaesth Intensive Care. 1983 Feb;11(1):4–15. doi: 10.1177/0310057X8301100102. [DOI] [PubMed] [Google Scholar]
  4. Cass W., Edelist G. Postspinal headache. Successful use of epidural blood patch 11 weeks after onset. JAMA. 1974 Feb 18;227(7):786–787. doi: 10.1001/jama.227.7.786. [DOI] [PubMed] [Google Scholar]
  5. Crawford J. S. Lumbar epidural block in labour: a clinical analysis. Br J Anaesth. 1972 Jan;44(1):66–74. doi: 10.1093/bja/44.1.66. [DOI] [PubMed] [Google Scholar]
  6. Crawford J. S. The second thousand epidural blocks in an obstetric hospital practice. Br J Anaesth. 1972 Dec;44(12):1277–1287. doi: 10.1093/bja/44.12.1277. [DOI] [PubMed] [Google Scholar]
  7. Kalas D. B., Hehre F. W. Continuous lumbar peridural anesthesia in obstetrics. 8. Further observations on inadvertent lumbar puncture. Anesth Analg. 1972 Mar-Apr;51(2):192–195. [PubMed] [Google Scholar]
  8. MacArthur C., Lewis M., Knox E. G., Crawford J. S. Epidural anaesthesia and long term backache after childbirth. BMJ. 1990 Jul 7;301(6742):9–12. doi: 10.1136/bmj.301.6742.9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. MacArthur C., Lewis M., Knox E. G. Investigation of long term problems after obstetric epidural anaesthesia. BMJ. 1992 May 16;304(6837):1279–1282. doi: 10.1136/bmj.304.6837.1279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Okell R. W., Sprigge J. S. Unintentional dural puncture. A survey of recognition and management. Anaesthesia. 1987 Oct;42(10):1110–1113. doi: 10.1111/j.1365-2044.1987.tb05181.x. [DOI] [PubMed] [Google Scholar]
  11. Ong B., Cohen M. M., Cumming M., Palahniuk R. J. Obstetrical anaesthesia at Winnipeg Women's Hospital 1975-83: anaesthetic techniques and complications. Can J Anaesth. 1987 May;34(3 ):294–299. doi: 10.1007/BF03015169. [DOI] [PubMed] [Google Scholar]
  12. Reynolds F. Epidural analgesia in obstetrics. BMJ. 1989 Sep 23;299(6702):751–752. doi: 10.1136/bmj.299.6702.751. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Scott D. B., Hibbard B. M. Serious non-fatal complications associated with extradural block in obstetric practice. Br J Anaesth. 1990 May;64(5):537–541. doi: 10.1093/bja/64.5.537. [DOI] [PubMed] [Google Scholar]
  14. Stride P. C., Cooper G. M. Dural taps revisited. A 20-year survey from Birmingham Maternity Hospital. Anaesthesia. 1993 Mar;48(3):247–255. doi: 10.1111/j.1365-2044.1993.tb06913.x. [DOI] [PubMed] [Google Scholar]
  15. VANDAM L. D., DRIPPS R. D. Long-term follow-up of patients who received 10,098 spinal anesthetics; syndrome of decreased intracranial pressure (headache and ocular and auditory difficulties). J Am Med Assoc. 1956 Jun 16;161(7):586–591. doi: 10.1001/jama.1956.02970070018005. [DOI] [PubMed] [Google Scholar]

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