• Manuel C Vallejo and Mark I Zakowski.
• Department of Medical Education, West Virginia University, Morgantown, WV, 26506, USA; Department of Anesthesiology, West Virginia University, Morgantown, WV, 26506, USA; Department of Obstetrics & Gynecology, West Virginia University, Morgantown, WV, 26506, USA. Electronic address: vallejom@hsc.wvu.edu.
• Best Pract Res Clin Anaesthesiol. 2022 May 1; 36 (1): 179-189.

AbstractEpidural analgesia, commonly used to alleviate labor pain, is not without complication. The most common complication associated with labor epidural analgesia (LEA) is Unintentional Dural Puncture (UDP), where many professionals go on to develop a Post Dural Puncture Headache (PDPH). Spinal anesthesia can also result in PDPH. Other complications of dural puncture necessitating further treatment include hospital readmission, persistent headache, persistent backache, cerebral venous thrombosis, subdural hematoma, postpartum depression, post-traumatic stress disorder, and decreased maternal breastfeeding. In this article, we will define and discuss the definition and diagnosis for PDPH, the pathophysiology of PDPH, PDPH treatment options including conservative therapy, pharmacologic therapy, and invasive procedural measures including the therapeutic epidural blood patch, prophylactic epidural blood patch, intrathecal catheter placement after UDP, and potential new therapies.Copyright © 2022 Elsevier Ltd. All rights reserved.

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