PREVENTION OF POST-DURAL PUNCTURE HEADACHE IN OBSTETRIC PATIENTS: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.56238/levv17n59-027Keywords:
Post-Dural Puncture Headache, Obstetric Anesthesia, Cesarean Section, Spinal PunctureAbstract
Introduction: Post-dural puncture headache remains one of the most relevant causes of maternal morbidity after neuraxial anesthesia in obstetric practice. Its clinical impact extends beyond pain alone and may impair mobility, breastfeeding, maternal-infant interaction, and overall postpartum recovery. Preventive strategies have therefore gained increasing importance in both cesarean delivery under spinal anesthesia and in cases of accidental dural puncture during labor epidural analgesia.
Objective: The primary objective of this systematic review was to evaluate the efficacy and safety of available preventive strategies for post-dural puncture headache in obstetric patients undergoing neuraxial anesthesia. Secondary objectives were to compare prophylactic approaches used after planned spinal anesthesia with those used after accidental dural puncture, to assess the effect of pharmacological prophylaxis on headache incidence and severity, to examine the preventive role of intrathecal catheter-based strategies, to appraise methodological quality and risk of bias, and to identify the main evidence gaps for future research.
Methods: A systematic review was conducted according to PRISMA principles using PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP. Clinical studies involving obstetric patients and preventive interventions for post-dural puncture headache were eligible, with a primary search window of the last five years and prespecified expansion if needed. Study selection and data extraction were performed independently, and risk of bias and certainty of evidence were assessed with established tools including RoB 2, ROBINS-I, QUADAS-2, and GRADE as applicable.
Results and Discussion: Nine studies met the inclusion criteria and were included in the final qualitative synthesis. The available evidence suggests that pharmacological strategies such as aminophylline, ondansetron, pregabalin, and acetaminophen plus caffeine may reduce the incidence or severity of post-dural puncture headache after cesarean delivery under spinal anesthesia, whereas evidence for dexamethasone and intrathecal morphine remains inconsistent. In patients with accidental dural puncture during labor epidural analgesia, intrathecal catheter placement showed the most consistent favorable trend, with possible reduction in headache occurrence and epidural blood patch requirement, although most supporting data were observational. Overall, the literature was heterogeneous, with variation in interventions, comparators, diagnostic criteria, and follow-up periods, which limited certainty of evidence and the strength of universal recommendations.
Conclusion: Current evidence supports the view that prevention of post-dural puncture headache in obstetric patients is possible, but no single strategy has yet demonstrated sufficiently consistent superiority for universal routine use. Pharmacological prophylaxis may be beneficial in selected cesarean populations, and intrathecal catheter placement appears promising after accidental dural puncture in experienced settings. Preventive decision-making should therefore remain individualized, evidence-based, and adapted to procedural context, patient risk, and local expertise.
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References
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