RT Book, Section
A1 Epstein, Jonathan
A1 Geier, Jacquiline
A2 Santos, Alan C.
A2 Epstein, Jonathan N.
A2 Chaudhuri, Kallol
SR Print(0)
ID 1108523279
T1 Postdural Puncture Headache
T2 Obstetric Anesthesia
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071786133
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1108523279
RD 2024/04/20
AB Postdural  puncture  headache  (PDPH)  continues  to  be  one  of  the  most  common  complications  of  neuraxial  anesthesia  used  in  obstetrics.  It  is  critical  that  the  obstetric  anesthesiologist  be  able  to  recognize  the  difference  between  PDPH,  the  incidence  of  which  may  approach  40%,  and  other  causes  of  postpartum  headache.1  PDPH  is  also  the  third  most  common  cause  of  litigation  stemming  from  neuraxial  anesthesia.2  In  fact,  claims  related  to  maternal  death  and  newborn  death/brain  damage  have  steadily  decreased  since  1990,  but  PDPH  settlements  have  seen  a  steady  increase.3  Retrospective  analysis  indicates  that  the  most  frequently  cited  reason  for  a  patient’s  deciding  to  pursue  legal  action  was  a  lack  of  full  disclosure  regarding  potential  for  PDPH  and/or  lack  of  follow-up  by  the  anesthesiologist.2  Although  the  headache  itself  is  the  usual  official  complaint,  it  seems  that  poor  communication  and  an  absence  of  empathy  is  what  actually  drives  the  majority  of  these  legal  actions.  Accordingly,  patients  should  be  counseled  about  the  risks  of  PDPH  prior  to  every  neuraxial  anesthetic.  If  a  Tuohy  needle  accidentally  punctures  the  dura,  it  is  imperative  that,  after  the  patient  is  comfortable,  the  potential  risk  of  headache  be  once  again  explained.  At  that  time,  the  patient  should  be  advised  of  specific  treatment  options  and  reassured  that  adequate  follow-up  will  be  available.