Long-term morbidity following dural puncture in an obstetric population

Immediate and long-term symptoms, particularly headache, are recognised complications of dural puncture. To investigate long-term symptoms, a case-controlled retrospective questionnaire study was performed. The questionnaire was sent to 194 mothers who had suffered either accidental dural puncture during the placement of an epidural catheter or had developed a significant headache following spinal anaesthesia. The mothers were questioned about the nature and severity of symptoms and the impact upon their normal daily lives. They were also asked about the type and efficacy of any treatment they had received for these symptoms. An equal number of controls matched for ethnicity, age, modes of delivery and needle type were also questioned. There was increased reporting of new long-term headache and neckache in the spinal study group and an increased reporting of new long-term backache in the accidental dural puncture group compared to the epidural controls. These symptoms had a significant impact upon the mother's daily life and in some instances lasted for years. Disappointingly, although epidural blood patching was beneficial in the short term, it failed to produce any reduction in the incidence of long-term symptoms.