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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2016 June;82(6):641-8
Risk factors of post-dural puncture headache receiving a blood patch in obstetric patients
Jean BARDON 1, Camille LE RAY 2, 3, Charles M. SAMAMA 1, Marie P. BONNET 1, 3 ✉
1 Department of Anesthesiology and Critical Care, Centre Hospitalier Universitaire Cochin Broca Hôtel Dieu, Hôpitaux Universitaires Paris Centre, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France; 2 Port Royal Maternity Unit, Department of Gynecology and Obstetrics, Centre Hospitalier Universitaire Cochin Broca Hôtel Dieu, Hôpitaux Universitaires Paris Centre, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France; 3 Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, Risks in Pregnancy Day-care Hospital Unit, Paris Descartes University, Paris, France
BACKGROUND: Post-dural puncture headache (PDPH) is one of the most frequent complications of neuraxial anesthesia and analgesia. The objective is to determine risk factors of PDPH receiving a blood patch in the obstetric population.
METHODS: Between November 2009 and January 2013, 10914 women delivered in Port Royal maternity unit (Paris, France). The incidence of PDPH receiving a blood patch was calculated among those who received neuraxial analgesia or anesthesia for delivery. Then we performed a case-control study to identify risk factors for PDPH receiving a blood patch by comparing women who experienced PDPH receiving a blood patch with some women randomly selected by computer among those who delivered during the study period (4 controls for 1 case, univariate and multivariate analysis).
RESULTS: Among the 10685 women who had neuraxial analgesia or anesthesia, 0.4% had a PDPH receiving a blood patch. In the univariate analysis, cervix dilatation ≥7 cm, lateral decubitus position during the neuraxial procedure and multiple punctures were significantly associated with PDPH receiving a blood patch, whereas maternal Body Mass Index, age, mode of delivery, performance at night and level of needle insertion were not. In the multivariate analysis, cervix dilatation ≥7 cm and multiple punctures significantly increased the risk of PDPH receiving a blood patch (odd ratios 6.5 [95% CI: 1.5-29.3] and 5.6 [95% CI: 2.2-14.0], respectively). Experience of the anesthesiologist was not associated with PDPH in both univariate and multivariate analysis.
CONCLUSIONS: In the obstetric population, a cervix dilation ≥7 cm during labor and multiple punctures are independent risk factors for PDPH receiving a blood patch.