Israeli Hospital Survey of the Treatment and Management of Post‐Dural Puncture Headache

Background: The prevalence of IDP (Inadvertent Dural Puncture) in OB population is 1.5%, of which 60% will go on to develop PDPH (Post Dural Puncture Headache). Due to this relatively high probability of developing PDPH, we conducted a national survey, examine various aspects surrounding PDPH, as well as understanding what may be effective management options.

Methods: A national survey was undertaken, in which representative of obstetrical anesthesia units throughout Israel were contacted to obtain information which included: hospital data, intern training, management of IDP, PDPH and EBP (Epidural Blood Patch) issues.

Results: A total of 23 hospitals were included in this study. 87% of hospitals did not perform prophylactic EBP. Most hospitals (78.3%) do not utilize saline injection into the epidural space; however, 4 hospitals (17.4%) did routinely perform such procedures when inadvertent dural puncture occurred and one hospital (4.3%) had no consistent pattern of use. In 95.7% of hospitals in our study, conservative treatment was initiated within 24-48 hours. Conservative treatment was included IV Fluids (91.3%), bedrest (73.9%), caffeine (60.9%).

Conclusion: In this national survey, we noted there is no consensus or clear guidelines in the management and treatment of PDPH. While EBP is the Gold Standard of treatment, prophylactic EBP is known to be ineffective. The majority of OB units institute conservative measures within 24-48 hours after which, performing EBP increases efficacy. In light of results, we hope this survey may provide guidance to improved treatment options.