Obese parturients and the incidence of postdural puncture headache after unintentional dural puncture

Abstract

6 Obese Parturients and the Incidence of Postdural Puncture Headache after Unintentional Dural Puncture Abstract Type: Original Research Feyce Peralta, M.D.1; Nicole Higgins, M.D.1; Laurie A. Chalifoux, M.D.1; Christian Stevens, M.D.1; Elizabeth Sanchez, M.D.2; Robert McCarthy, Ph.D.1 Northwestern University Feinberg School of Medicine1; Loyola University2Type: Original Research Feyce Peralta, M.D.1; Nicole Higgins, M.D.1; Laurie A. Chalifoux, M.D.1; Christian Stevens, M.D.1; Elizabeth Sanchez, M.D.2; Robert McCarthy, Ph.D.1 Northwestern University Feinberg School of Medicine1; Loyola University2 Background: An inverse relationship between body mass index (BMI) and postdural puncture headache (PDPH) incidence after unintentional dural puncture (UDP) has been suggested despite a lack of peer reviewed evidence. The proposed mechanism is based on the knowledge that lumbar epidural pressure is increased during term pregnancy while CSF pressure remains unchanged.1,2 It has also been shown that obese patients have decreased CSF volume compared to lean individuals.3 These findings suggest that a decreased intrathecal-epidural pressure gradient, Resulting in less CSF leak through the dural rent, may explain a lower incidence of PDPH. We hypothesized that parturients with a BMI>35 kg/m2 have a lower incidence of PDPH than those with BMI 35 kg/m2). The primary outcome was incidence of PDPH. Groups were compared using a chisquared statistic. Post hoc comparisons were made using the Bonferroni Method. P 35 group (P 35.4 Therefore, when managing these parturients, one can consider the placement of intrathecal catheters for labor analgesia/anesthesia.