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Accidental dural puncture is a recognized complication of epidural insertion for labor analgesia, and its incidence is reported to be 1.
2-2.
6%
.
Dural puncture and subsequent intracranial hypotension can activate the trigeminal nerve cervical complex and cause headaches after dural puncture.
management
Although headache after epidural puncture can cause great pain and morbidity in the short term, it is generally considered to be a self-limiting disease.
The International Headache Association's definition of headache after epidural puncture also reflects this consensus
.
However, evidence from retrospective studies suggests that accidental dural puncture may be related to persistent headaches
.
In addition, there is low-quality evidence that accidental dural puncture and subsequent epidural replenishment may actually increase the risk of new low back pain
To further investigate this issue, the investigators conducted a multicenter, prospective matched cohort study to assess the incidence of persistent headache 18 months after accidental dural puncture in the obstetric population during epidural insertion
.
The researchers hypothesized that women who have an accidental dural puncture during an epidural puncture will have a significantly higher incidence of persistent headaches than women who have an unsuccessful epidural puncture
We conducted a prospective multicenter cohort study that evaluated the incidence of persistent headaches after accidental dural puncture in 9 obstetric units in the UK
.
Women who had undergone an accidental dural puncture were matched with a control group who had received a smooth epidural puncture
The results of the study showed that the incidence of persistent headache at 18 months in the accidental puncture group was 58.
4% (52/89), and the control group was 17.
4% (29/167), and the odds ratio (95% CI) was 18.
4 (6.
0-56.
7) , P<0.
001, after adjusting the scores of past headache history, hospital anxiety and depression scale (depression) and hospital anxiety and depression scale (anxiety)
.
The incidence of low back pain at 18 months was 48.
We have shown that accidental dural puncture is associated with long-term morbidity, including persistent headaches by obstetricians
.
This poses a challenge to the current definition of post-dural puncture headache as a self-limiting disease, and raises possible clinical, financial and legal consequences
Original source:
Original source:Persistent headache and low back pain after accidental dural puncture in the obstetric population: a prospective, observational, multicentre cohort study.
Persistent headache and low back pain after accidental dural puncture in the obstetric population: a prospective, observational, multicentre cohort study.
DOI:https://doi.
org/10.
1111/anae.
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