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

Publication ,  Journal Article
Mims, SC; Tan, HS; Sun, K; Pham, T; Rubright, S; Kaplan, SJ; Habib, AS
Published in: J Clin Anesth
August 2022

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.

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Published In

J Clin Anesth

DOI

EISSN

1873-4529

Publication Date

August 2022

Volume

79

Start / End Page

110787

Location

United States

Related Subject Headings

  • Uridine Diphosphate
  • Spinal Puncture
  • Punctures
  • Prospective Studies
  • Pregnancy
  • Post-Dural Puncture Headache
  • Neck Pain
  • Morbidity
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Mims, S. C., Tan, H. S., Sun, K., Pham, T., Rubright, S., Kaplan, S. J., & Habib, A. S. (2022). Long-term morbidities following unintentional dural puncture in obstetric patients: A systematic review and meta-analysis. J Clin Anesth, 79, 110787. https://doi.org/10.1016/j.jclinane.2022.110787
Mims, Sierra C., Hon Sen Tan, Katherine Sun, Trung Pham, Samantha Rubright, Samantha J. Kaplan, and Ashraf S. Habib. “Long-term morbidities following unintentional dural puncture in obstetric patients: A systematic review and meta-analysis.J Clin Anesth 79 (August 2022): 110787. https://doi.org/10.1016/j.jclinane.2022.110787.
Mims SC, Tan HS, Sun K, Pham T, Rubright S, Kaplan SJ, et al. Long-term morbidities following unintentional dural puncture in obstetric patients: A systematic review and meta-analysis. J Clin Anesth. 2022 Aug;79:110787.
Mims, Sierra C., et al. “Long-term morbidities following unintentional dural puncture in obstetric patients: A systematic review and meta-analysis.J Clin Anesth, vol. 79, Aug. 2022, p. 110787. Pubmed, doi:10.1016/j.jclinane.2022.110787.
Mims SC, Tan HS, Sun K, Pham T, Rubright S, Kaplan SJ, Habib AS. Long-term morbidities following unintentional dural puncture in obstetric patients: A systematic review and meta-analysis. J Clin Anesth. 2022 Aug;79:110787.
Journal cover image

Published In

J Clin Anesth

DOI

EISSN

1873-4529

Publication Date

August 2022

Volume

79

Start / End Page

110787

Location

United States

Related Subject Headings

  • Uridine Diphosphate
  • Spinal Puncture
  • Punctures
  • Prospective Studies
  • Pregnancy
  • Post-Dural Puncture Headache
  • Neck Pain
  • Morbidity
  • Male
  • Humans