PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies

PurposePostdural puncture headache (PDPH) is an iatrogenic complication of neuraxial blockade. We systematically reviewed the literature on parturients to determine the frequency onset, and duration of PDPH.MethodsCitations on PDPH in the obstetrical population were identified by computerized searches, citation review, and hand searches of abstracts and conference proceedings. Citations were included if they contained extractable data on frequency, onset, or duration of PDPH. Using meta-analysis, we calculated pooled estimates of the frequency of accidental durai puncture for epidural needles and pooled estimates of the frequencies of PDPH for epidural and spinal needles.ResultsParturients have approximately a 1.5% [95% confidence interval (CI) 1.5% to 1.5%) risk of accidental durai puncture with epidural insertion. Of these, approximately half (52.1%; 95% CI, 51.4% to 52.8%) will result in PDPH. The risk of PDPH from spinal needles diminishes with small diameter, atraumatic needles, but is still appreciable (Whitacre 27-gauge needle 1.7%; 95% CI, 1.6% to 1.8%). PDPH occurs as early as one day and as late as seven days after durai puncture and lasts 12 hrto seven days.ConclusionPDPH is a common complication for parturients undergoing neuraxial blockade.