Clinical Consideration of Headache Following Accidental Dural Puncture

Kim, Dong Yeon; Kim, Jong Hak; Lee, Choon Hi

Abstract

BACKGROUND: Puncture of the dura can lead to a severe and often incapacitating headache. There is a report that the frequency of headache following accidental dural puncture with a 17 or 18 gauge needle is 86.7%. We reviewed the records to evaluate the efficacy of management for all patients whose epidural for postoperative pain control was complicated by dural puncture during a 3-year period.
METHODS
The subject of patients in whom dural puncture occurred (35 cases in 1574 epidurals) was divided into two group. Group W5 consisted of 16 patients who received epidural saline and drugs in a rate of 5 ml/hr. Group W10 consisted of 19 patients who received epidural saline and drugs in a rate of 10 ml/hr. All patients were monitored daily by the pain control resident for occurrence of headache.
RESULTS
The frequency of accidental dural puncture was 2.2% (35 cases of 1574 epidurals). In group W5, 6 of 16 patients (38%) experienced headache. In group W10, 6 of 19 patients (32%) experienced headache. There were no significant differences between both groups.
CONCLUSIONS
The results of this study suggest that the epidural infusion with high volume of 0.9% saline and drugs should be considered as an alternative effective method of managing postdural puncture headache.