Incidence and Management of Accidental Dural Puncture and Postdural Puncture Headache in Parturients: Retrospective Database Study

Eur J Anaesthesiol . 2025 Jun 1;42(6):492–499. doi: 10.1097/EJA.0000000000002130. Pain relief during labor and delivery commonly includes neuraxial anesthesia and/or analgesia. Postdural puncture headache (PDPH) can occur following a neuraxial technique where the dura is punctured either intentionally for spinal anesthesia or unintentionally during epidural analgesia. Accidental dural puncture with a Tuohy needle (ADP) is estimated at a frequency of >1.5%, and PDPH occurs in more than half of those cases. PDPH symptoms can be severe in the acute phase and can lead to chronic headache, backache, postpartum depression, and other long-term complications. Estimates of prevalence for PDPH and ADP remain uncertain, with reported rates showing high variability as well as a high degree of uncertainty. This study was designed to assess the rates and trends of PDPH after neuraxial block and ADP after labor epidural analgesia (LEA) between 2017 and 2022, with the hypothesis that reported rates of each event increase after improved policies and systems surrounding recording accuracy and real-time documentation.