Abstract
Postdural puncture headache (PDPH) is an incapacitating complication that can occur following spinal anesthesia and with inadvertent dural puncture during epidural anesthesia. We present a case of a 32-year-old G2P1 female who was admitted for induction of labor and received epidural catheter placement for analgesia. After an inadvertent dural puncture and development of a PDPH, the patient was offered conservative measures for the first 48 hours without improvement. An epidural blood patch (EBP) was placed achieving only moderate relief. Two days later, a second EBP was performed and the patient developed severe back pain which radiated bilaterally to her buttocks. Magnetic resonance imaging (MRI) demonstrated the presence of blood in the intrathecal space. This could be the cause of sacral radiculitis, an uncommon complication of an EBP. This suggests that EBPs could potentially cause neurologic symptoms which may be more common than people previously thought. As complicated outcomes have followed both conservative and aggressive management, MRI can be an early diagnostic tool in such cases and a multidisciplinary approach should be taken.
Highlights
Postdural puncture headache (PDPH) has been a known neuraxial complication since the first spinal anesthesia was performed in 1898 by Dr August Bier[1]
Labor epidural analgesia is the routine form of pain management for obstetric patients
The PDPH tends to have classic symptoms among which a positional fronto-occipital throbbing headache is the cardinal feature accompanied by nausea, vomiting, tinnitus, hypoacusia, ocular disturbances, and neck stiffness[8,9]
Summary
Postdural puncture headache (PDPH) has been a known neuraxial complication since the first spinal anesthesia was performed in 1898 by Dr August Bier[1]. Inadvertent dural puncture during epidural placement is a more common cause of PDPH. Accidental puncture of the dura mater occurred in 1.5% of the obstetric patients, and more than half of them developed PDPH[2]. Most PDPH has been treated successfully with bed rest, hydration, caffeine, and over-the-counter analgesics, some require more aggressive management with epidural blood patch (EBP).
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