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Treatment of obstetric post-dural puncture headache. Part 1: conservative and pharmacological management
R Russell1, C Laxton2, D N Lucas3
1Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Abstract:
The 2009-12 MBRRACE-UK report highlighted the deaths of two women in whom dural puncture had occurred during insertion of a labour epidural catheter. One woman received an epidural blood patch, the other did not, but both suffered with chronic headaches following discharge from hospital. Neither woman was adequately followed-up. Death resulted from a cerebral vein thrombosis in one case and a subdural haematoma in the other. Surveys of clinical practice in the UK have revealed significant variation in anaesthetic practice in the management of obstetric post-dural puncture headache. To help provide guidance on treatment, the Obstetric Anaesthetists' Association set up a working group to review the literature and produce evidence-based guidelines for management of obstetric post-dural puncture headache. These guidelines have been condensed into two review articles, the first of which covers conservative and pharmacological treatment.
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