Nonpharmacologic Neuraxial Interventions for Prophylaxis of Postdural Puncture Headache in the Obstetric Patient

Postdural puncture headache due to accidental dural puncture during epidural catheter placement is a source of morbidity for new mothers. It can interfere with maternal-newborn bonding and increase the length of hospitalization. This evidence-based article examined the question: For obstetric patients experiencing an accidental dural puncture during epidural placement, which nonpharmacologic prophylactic neuraxial interventions safely and effectively decrease the incidence of postdural puncture headache? A search of online databases revealed 4 systematic reviews with meta-analysis and a randomized controlled trial meeting the inclusion criteria. Three of the 4 systematic reviews used rigorous appraisal methods. Two systematic reviews included nonobstetric populations and 3 included additional interventions. Subgroup analyses allowed examination of the interventions of interest. Nonpharmacologic prophylactic neuraxial interventions included prophylactic epidural blood patch, epidural saline administration, and intrathecal catheter placement. There was a lack of standardization of interventions. The evidence suggested there may be value in performing a prophylactic blood patch or placing an intrathecal catheter. The risk of the intervention must be carefully weighed with the benefits. Further rigorous studies are needed to help determine the best methods to decrease the incidence of postdural puncture headache in obstetric patients experiencing an accidental dural puncture during epidural placement.