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Incidence and Risk Factors for Post-Dural Puncture Headache (PDPH) in Patients Receiving Neuraxial Anesthesia for
William P Qiao1,2, Juliet E Rowe1, Pa Thor1
1Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA.
Background:
Post-dural puncture headache (PDPH) after unintended dural puncture is a known complication of neuraxial anesthesia, especially with puncture by 20 gauge or larger catheter or needle. PDPH can impact post-operative recovery; however, PDPH in patients undergoing total joint arthroplasty (TJA) is less well documented because the majority of studies address obstetric patients.
Purposes:
We sought to answer the following questions: What is the incidence of PDPH after unintended dural puncture in the TJA population? What are risk factors for PDPH? How is PDPH managed?
Methods:
A retrospective chart review was performed for patients undergoing TJA surgeries under neuraxial anesthesia between January 1, 2016, and April 30, 2023, at a single high-volume orthopedic hospital. Cases with documented dural puncture with 20 gauge epidural catheter, 18 gauge Weiss epidural needle, or 17 gauge Weiss epidural needle were identified and reviewed for PDPH.
Results:
Among 77 586 patients who received neuraxial anesthesia of any kind (spinal, epidural, combined spinal/epidural), 640 patients (0.8%) experienced unintended dural puncture and were included in the analysis. Among those with unintended dural puncture, 29 (4.5%) patients subsequently developed PDPH. The final logistic regression identified older age and higher body mass index (BMI) as protective and associated with reduced risk of PDPH. Among the 29 PDPH cases, non-steroidal anti-inflammatory drugs were employed in 86.2% of patients, and acetaminophen was used in 93.1%. Seven patients (24.1%) required an epidural blood patch, and 3 (10.3%) reported long-term sequelae.
Conclusions:
This large retrospective case series of TJA patients at a single institution found that the incidence of PDPH after unintended dural puncture was low (4.5%). Lower age and lower BMI were risk factors associated with higher odds of being diagnosed with PDPH.
Level Of Evidence:
Level IV: retrospective case series.
