Chronic consequences of accidental dural puncture and postdural puncture headache in obstetric anaesthesia - sieving through the evidence.

PURPOSE OF REVIEW

Accidental dural puncture (ADP) and postdural puncture headache (PDPH) are relatively common complications of neuraxial anaesthesia and analgesia in obstetrics. Both may result in acute and chronic morbidity. This review intends to discuss the chronic implications of ADP and PDPH and raise awareness of severe and potentially life-threatening conditions associated with them.

RECENT FINDINGS

ADP may be associated with a high rate of PDPH, prolonged hospitalization and increased readmissions. Studies have shown that PDPH may lead to chronic complications such as post-partum depression (PPD), post-traumatic stress disorder (PTSD), chronic headache, backache and reduced breastfeeding rates. There are many case reports indicating that major, severe, life-threatening neurologic complications may follow PDPH in obstetric patients including subdural haematoma and cerebral venous thrombosis.

SUMMARY

Many clinicians still believe that ADP and PDPH are benign and self-limiting conditions whereas there may be serious and devastating consequences of both. It is imperative that all women with ADP and PDPH are appropriately diagnosed and treated.