Long-term morbidities following unintentional dural puncture in obstetric patients: A systematic review and meta-analysis

Sierra C Mims; Hon Sen Tan; Katherine Sun; Trung Pham; Samantha Rubright; Samantha J Kaplan; Ashraf S Habib

doi:10.1016/j.jclinane.2022.110787

Long-term morbidities following unintentional dural puncture in obstetric patients: A systematic review and meta-analysis

J Clin Anesth. 2022 Aug:79:110787. doi: 10.1016/j.jclinane.2022.110787. Epub 2022 Mar 28.

Authors

Sierra C Mims¹, Hon Sen Tan², Katherine Sun¹, Trung Pham¹, Samantha Rubright¹, Samantha J Kaplan³, Ashraf S Habib⁴

Affiliations

¹ Department of Anesthesiology, Duke University School of Medicine, 2301 Erwin Road, Box 3094, Durham, NC 27710, United States of America.
² Department of Women's Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Republic of Singapore.
³ Duke University Medical Center Library & Archives, 103 Seeley G. Mudd Building, Durham, NC 27710, United States of America.
⁴ Department of Anesthesiology, Duke University School of Medicine, 2301 Erwin Road, Box 3094, Durham, NC 27710, United States of America. Electronic address: ashraf.habib@duke.edu.

PMID: 35358942
DOI: 10.1016/j.jclinane.2022.110787

Abstract

Study objective: To investigate the association of unintentional dural puncture (UDP) and postdural puncture headache (PDPH) with the risk of chronic headache, backache, neckache and depression. We also investigated if epidural blood patch (EBP) is associated with reduced risk of these morbidities.

Design: Systematic review and meta-analysis.

Patients: Pregnant women who experienced UDP and/or PDPH versus those who had uneventful neuraxial procedures, and women who received EBP versus those who did not.

Interventions: None.

Measurements: Primary outcomes were headache, backache, and neckache lasting ≥12 months, and depression ≥1 month. Secondary outcomes included chronic headache, backache, and neckache persisting ≥1 and ≥ 6 months, and the effects of EBP on those outcomes at ≥1 and ≥ 12 months. Subgroup analyses of prospective studies and sensitivity analyses of primary outcomes excluding poor quality studies were performed.

Main results: Twelve studies compared 6541 women with UDP and/or PDPH versus 1,004,510 with uncomplicated neuraxial procedures. Eight studies compared EBP (n = 3610) with no EBP (n = 3154). UDP and/or PDPH were associated with increased risk of headache (RR 3.95; 95%CI 2.13 to 7.34; I² 42%), backache (RR 2.72; 95%CI 2.04 to 3.62; I² 1%), and neckache (RR 8.09; 95%CI 1.03 to 63.35) persisting ≥12 months, and depression (RR 3.12; 95%CI 1.44 to 6.77; I² 90%) lasting ≥1 month. Results were consistent in analyses at ≥1 and ≥ 6 months, subgroup analyses of prospective studies, and after exclusion of one poor-quality study from our primary outcome. EBP was not associated with significant reduction in the risk of long-term morbidities.

Conclusions: UDP and/or PDPH were associated with increased risk of chronic headache, backache, neckache, and depression. EBP was not associated with a significant reduction in those risks, but this conclusion is limited by the heterogeneity of current data and lack of information on the success of EBP in relieving acute PDPH symptoms.

Keywords: Chronic morbidity; Dural puncture; Epidural; Headache; Labor analgesia.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Back Pain / epidemiology
Back Pain / etiology
Blood Patch, Epidural / adverse effects
Female
Headache / epidemiology
Headache / etiology
Headache Disorders*
Humans
Male
Morbidity
Neck Pain / etiology
Post-Dural Puncture Headache* / epidemiology
Post-Dural Puncture Headache* / etiology
Pregnancy
Prospective Studies
Punctures
Spinal Puncture
Uridine Diphosphate

Substances

Uridine Diphosphate