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Long-term complications of unintentional dural puncture during labor epidural analgesia: a case–control study
  1. Alexandre Lacombe1,
  2. Kristi Downey1,
  3. Xiang Y Ye2 and
  4. Jose C A Carvalho1
  1. 1 Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
  2. 2 Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Alexandre Lacombe, Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; alexandre.lacombe2{at}mcgill.ca

Abstract

Introduction Epidural analgesia is the preferred method to manage pain during labor and delivery. The insertion of the epidural catheter can be complicated by unintentional dural puncture that may result in postdural puncture headache. There is limited evidence on the long-term implications of this complication. We sought to investigate if women who sustained a dural puncture have a higher risk of developing chronic headache, low back pain and visual or auditory impairment.

Methods We conducted a 1:1 case–control study with women who delivered at our institution from January 2015 to December 2019. Cases were women who received epidural analgesia and sustained an unintentional dural puncture, and controls were women who received epidural analgesia but did not sustain such complication. We matched cases and controls for date of delivery, age, and body mass index. All women completed an online survey with validated questionnaires for diagnosis of chronic headache and chronic back pain. We used dichotomic (yes/no) questions to look for the presence of chronic visual and auditory impairment.

Results Sixty-three case–control pairs were studied. Women who sustained a dural puncture during their epidural catheter insertion had a higher risk of developing chronic headache (14.3%, vs 4.8%, p=0.057, adjusted OR (AOR): 3.67 (95% CI 1.05 to 12.82)) and chronic back pain (39.7% vs 19.1%, p=0.009, AOR: 2.67 (95% CI 1.25 to 5.72)) than women who did not sustain a dural puncture. The incidence of chronic auditory impairment was also higher in the dural puncture group (14.3% vs 1.6%, p=0.01, AOR: 9.98 (95% CI 1.21 to 82.62)).

Conclusions An unintentional dural puncture during epidural catheter insertion in parturients is associated with increased risk of chronic headache, back pain and auditory impairment.

  • Post-Dural Puncture Headache
  • Obstetrics
  • CHRONIC PAIN
  • REGIONAL ANESTHESIA
  • Back Pain

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Not applicable.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Not applicable.

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Footnotes

  • Twitter @kdurettedowney, @josecarvalhoyyz

  • Contributors AL, KD, XYY and JCAC contributed to study design, data analysis and interpretation and manuscript writing. AL and KD contributed to data collection. AL is responsible for the overall content as guarantor.

  • Funding JCAC is supported by the Merit Awards Program from the Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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