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Background and Aims This paper reports on efforts to manage post-dural puncture headache (PDPH). At our institution, 80% of cases of anaesthesia are managed in the perinatal period, and we have introduced a protocol to ensure that complications after zonal anaesthesia are identified without omission and that patients are safely discharged without serious complications. Subjects:38 cases of suspected PDPH after anaesthetic management of caesarean section or painless delivery between February 2021 and November 2022.

Methods The date of anaesthesia, method of delivery and anaesthesia, presence or absence of dural puncture and details (medical or accidental puncture, type of puncture needle) and examination items such as main symptoms, concomitant symptoms and initial response were recorded, and the examination items were examined daily and recorded in a list available to the public. Treatment was given at the appropriate time while sharing the progress, and consultations were carried out until the symptoms improved and the intervention was completed.

Results Of 3590 obstetric anaesthesia cases, 38 were suspected to have PDPH, 25 with main symptoms only and 13 with associated symptoms. Conservative treatment was used in 27 cases, epidural autologous blood infusion in 11 cases, and discharge was postponed in 10 cases.

Conclusions In Japan, hospitalisation lasts approximately one week after delivery, but this protocol provides a system that can be used immediately after discharge from hospital after a short hospitalisation. No serious complications were observed with this protocol and the intervention was carried out at the appropriate time.