[Dural puncture in obstetric analgesia. Epidemiologic features and therapeutic management]

To assess the time of occurrence, circumstances and presenting symptoms of unintentional dural puncture (UDP), the location and intensity of postdural puncture headaches (PDPH), and the efficacy of their treatment by epidural blood-patch (EBP).

Cohort study.

Cases of UDP recorded over a 4-year period in an obstetric anaesthesia unit.

The following variables were studied: maternal age, weight and height, hour of occurrence and number of puncture attempts, existence of reflux of cerebrospinal fluid (CSF) through the needle, experience of the practitioners, subsequent modalities of obstetrical analgesia, frequency of occurrence, clinical characteristics and therapeutic management of PDPH. In case of EBP, the amount of blood and the efficacy of the procedure were also recorded.

Twenty-one patients presented with UDP (0.66%). No reflux of CSF was identified in nine cases. Most UDP occurred at the first or second attempt, usually when performed by a practitioner poorly trained in epidural analgesia in obstetrics. The risk of UDP was higher during night-time work (risk ratio: 3.0; 95% confidence interval: 1.1-8.0; p = 0.04). Subsequent analgesia was provided via the epidural route in 19 cases, subarachnoidal route in one, and intravenous route in one case. PDPH did not develop in two patients. Three patients were given prophylactic EPB, and 16 received curative EBP. A second EBP was required 24 h later in seven patients. One patient developed meralgia paresthetica following EBP.

In parturients, UDP usually results in PDPH. A rapid and effective treatment is required, mainly EBP. Another EBP is eventually necessary in some patients.