47 Incidence and management of post-dural puncture headache and accidental dural puncture from an oncology hospital: a 5-year retrospective analysis

Background and Aims Accidental dural puncture (ADP) and post–dural puncture headache (PDPH) are epidural anaesthesia’s complications. There’s limited evidence in non–obstetric patients and no consensus management. The aim of this study was to evaluate its incidence and approach in an institution where combined epidural-general anaesthesia is preferential. Methods Retrospective analysis (SPSS V.26) was conducted of adult patients submitted to elective surgery with combined epidural-general anaesthesia and suffered ADP, april 2015–2020. Information about the patient’s background, epidural procedure, PDPH management and clinical evolution was collected from clinical records. Results 3237 patients have had a combined epidural-general anaesthesia, 31 suffered ADP (0,96%). 61,3% were female, 71% ASA II, mean age 59,61 years. 6 patients developed PDPH, 1 without previous ADP identification, resulting in an incidence of PDPH of 19,35%. This incidence was not statically different in patients in whom the catheter was re-sited (n=5) comparing to the ones that were not (n=1). All patients were treated conservatively, although not uniformly. The onset of headache was on average 48h (24–72h) postoperative and with an average duration of 48h (24–96h). 5 patients were submitted to prophylactic treatment for PDPH and only 1 developed PDPH; comparing to 5 in 26 that did not receive prophylactic treatment, although not statistically different. This study was approved by the Ethics Committee. Conclusions The incidence of ADP and PDPH were lower than that reported in literature. Conservative treatment for PDPH was enough to manage this condition efficiently. The approach is not uniform, emphasizing the need of clinical protocol.