Post-dural puncture headache

Neuraxial analgesia and anesthesia are widely used in obstetric anesthesia. The most frequent complication after neuraxial blocks is post-dural puncture headache. It can occur after unintentional dural puncture during epidural procedures or after spinal anesthesia. Unintentional dural puncture occurs in 0.15-1.5% of labor epidural analgesia and 50-80% of these women develop post-dural puncture headache. The headache is typically orthostatic in nature and can be so incapacitating that the mother becomes bedbound and is no longer able to care for herself and her newborn child. A wide variety of prophylactic and therapeutic measures have been tried. So far, the therapeutic epidural blood patch is the only treatment for which there is enough evidence to recommend its routine use for severe cases of post-dural puncture headache. Larger multicenter trials are needed to back up alternative treatment strategies.