Dural puncture: the patients' perspective. A patient survey of cases at a DGH maternity unit 1983-1993.

BACKGROUND: This study was designed to investigate the patient experience following accidental dural puncture complicating obstetric epidural analgesia.

METHODS: Sixty-three patients who had suffered from accidental dural puncture during obstetric epidural analgesia over a ten-year period were sent a questionnaire enquiring about their experiences. 68% responded.

RESULTS: Headache was the most severe symptom, occurring in 86% of this group; it lasted for a median of eight days and recurred after discharge in 47%. Backache occurred in 70% and 58% suffered with backache following discharge. Headache was considered to be the worst aspect by 49% of responders, backache by 19% and bedrest by 33%. Bed rest was frequently voluntary (as opposed to being enforced on medical orders) since many patients only gained relief from their headache when supine. Twenty patients (47%) received a blood patch, which was effective in relieving headache in 14 patients; however, the headache recurred after discharge in 10 of these 14 patients. Only 8 patients (19%) stated that they were aware of the risk of dural puncture prior to their epidural, three of whom were members of paramedical professions.

CONCLUSIONS: Headache and backache are both common following dural puncture with a 16 G needle and both frequently recur after discharge from hospital. It was the strongly expressed opinion of this selected group that all mothers should be warned of the risk of dural puncture before undergoing epidural analgesia.