SummaryThe records .from 34 819 obstetric epidurals performed at Birmingham Maternity Hospital over the period 1969-1988 were examined. During that time there were 460 dural taps (overall incidence 1.3%). Of the methods used to detect the epidural space, loss of resistance to injection of saline was associated with the lowest incidence of dural tap (0.6%). The incidence of typical postdural puncture headache when managed conservatively was 86%. Provision of an epidural drip after delivery reduced the incidence of headache to 70%. Elective .forceps delivery conferred no additional benefit. and tended to delay the onset of headache. Blood patches were perjormed on 135 patients and provided complete relief of headache in 93 (68%). A .further 23 patients (16%) obtained partial relief:
Key wordsAnaesthetic techniques, regional; epidural. Complications; dural puncture. Anaesthesia; obstetric.The epidural service at Birmingham Maternity Hospital (BMH) was started in 1968. During the 20-year period 1969-1988, full records of 34 819 epidurals were collected in a standardised way and were available for scrutiny; 460 inadvertent dural punctures (dural taps) were documented.The size of this database offered an unparalleled opportunity to investigate factors affecting the incidence of dural tap in the obstetric patient, and the prevention and management of its sequelae. Although very low dural tap rates have been reported, this problem can never be totally eliminated wherever an epidural service is offered. Subsequent postdural puncture headache (PDPH) can be a particularly distressing condition in this group of patients. It is important that the anaesthetist be well-informed of the implications of dural tap and the management options available. so that this distress can be minimised.