Chronic headache and backache are long-term sequelae of unintentional dural puncture in the obstetric population

•Chronic headache and backache sequelae persist in the obstetrical population after unintentional dural puncture (UDP).•Most parturients are not followed up for long-term sequelae, and many institutions do not have standardized protocols for treatment and follow-up.•Short- and long-term follow-up of parturients with a documented UDP is indicated.•Because there are no proven methods in the prevention of an UDP, vigilance during neuraxial insertion is best in avoiding UDP and postdural puncture headache and its long-term consequences.•When parturients are considering labor epidural analgesia, long-term sequelae should be discussed in the informed consent decision-making process for labor epidural analgesia.

IntroductionUnintentional dural puncture (UDP) and postdural puncture headache (PDPH) occur during the course of epidural catheter placement for labor analgesia with a reported incidence of 1%-5%. After UDP with an epidural needle, 80%-86% of patients develop PDPH. Acute symptoms after UDP are well known. However, few studies have evaluated the long-term complications of UDP, which is important in assisting parturients in the decision-making informed consent process. We sought to elucidate the long-term (> 6 weeks) sequelae of PDPH by examining parturients who had UDP (both recognized and unrecognized) associated with labor epidural analgesia.MethodsParturients with a documented UDP (n = 308) over a 5-year period were followed up for acute and long-term residual symptoms (lasting > 6 weeks) and compared with a control group (no documented UDP, n = 50) in the same period. Specific symptoms included headache, backache, neck ache, auditory symptoms, and visual symptoms.ResultsIn comparing parturients with a UDP with control group (no UDP), differences were noted in overall acute symptoms (75.9% vs 21.7%, P < .001), specifically headache (87.0% vs 8.7%, P < .001), backache (47.2% vs 19.6%, P = .002), neck ache (30.1% vs 2.2%, P < .001), auditory (13.8% vs 0%, P = .02), and visual symptoms (19.5% vs 0%, P = .002). Differences were also noted in comparing chronic symptoms (26.5% vs 10.9%, P = .04) and specifically with respect to chronic headache (34.9% vs 2.2%, P < .001), backache (58.1% vs 4.4%, P < .001), and neck ache (14.0% vs 0%, P = .02). No differences were noted between groups in comparing chronic auditory and visual symptoms.ConclusionChronic headache and backache sequelae persist in the obstetrical population after UDP. When parturients are considering labor epidural analgesia, long-term sequelae should be discussed in the informed consent decision-making process.