Background Post-dural puncture headache (PDPH) remains the most frequent complication of neuraxial anaesthesia, particularly following accidental dural puncture (ADP). Although often self-limiting, PDPH contributes to significant morbidity and prolonged inpatient stay, increasing medico-legal risk. Recent guidelines emphasise structured documentation, early recognition, and preventive measures such as intrathecal catheter (ITC) placement. This audit aimed to evaluate the incidence, risk factors, management patterns, and outcomes of PDPH at a tertiary obstetric unit over six years, with a specific focus on the effectiveness of intrathecal catheterisation following ADP. Methods Institutional records were reviewed for all patients diagnosed with PDPH between 2019 and 2025. Data collected included demographics, anaesthetic techniques, ADP incidence, management approach, and outcomes. Descriptive statistics were used to summarise findings and any trends that may have changed over time. Results Among 3,594 spinal epidural procedures, 63 cases of PDPH were identified (1.75%). ADP occurred in 15 patients (0.42%), of whom 10 (66.7%) received ITC placement. Headache developed in 2 of 10 patients with a catheter (5%), compared with four of five without (10.3%). PDPH incidence rose from 0.03% in 2019 to 0.61% in 2023, then declined to 0.28% in 2025. Conclusion PDPH incidence and ADP rates in this institution were comparable to international data. Intrathecal catheterisation following ADP was associated with a lower likelihood of headache. The findings support the continued use of preventive strategies, structured documentation, and early recognition protocols to optimise PDPH management and outcomes.
Jossie et al. (Tue,) studied this question.
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