Post-dural puncture headache in the obstetric patient: an old problem. New solutions

More than 100 years have passed since the initial description of the postdural puncture headache (PDPH). However, this unique clinical entity still continues to fascinate anesthesiologists, and numerous studies on its pathophysiology, prevention, and treatment, have been published. There is considerable variability in the incidence of PDPH, which is affected by many factors such as age, gender, pregnancy, and needle type and size. The obstetric patient is at particular risk of dural puncture (and the subsequent headache) because of sex, young age, and the widespread application of regional anesthesia. The incidence of epidural needle-induced PDPH in parturients following dural puncture with a large bore needle has been reported to range 76-85%. Although a few measures have been proposed to prevent PDPH (intrathecal injection of saline, insertion of the epidural catheter into the subarachnoid space through the dural hole), none have been shown to work with certainty to date. This article reviews the latest developments (maintaining cerebrospinal fluid volume) aimed at prevention of PDPH.