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Obstetric Analgesia: Case Report
Subdural Hematoma Associated With Labor Epidural Analgesia: A Case Series
  1. Grace Lim, MD*,
  2. Jamie M. Zorn, MD*,
  3. Yuanxu J. Dong, MD*,
  4. Joseph S. DeRenzo, MD* and
  5. Jonathan H. Waters, MD*,†
  1. From the *Department of Anesthesiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA; and †The McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA
  1. Address correspondence to: Grace Lim, MD, Department of Anesthesiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital, 300 Halket St, Suite 3510, Pittsburgh, PA 15213 (e-mail: limkg2{at}upmc.edu).

Abstract

Objective This report aimed to describe the characteristics and impact of subdural hematoma (SDH) after labor epidural analgesia.

Case Reports Eleven obstetric patients had SDHs associated with the use of labor epidural analgesia over 7 years at a tertiary care hospital. Ten of 11 patients had signs consistent with postdural puncture headache before the diagnosis of SDH. Five patients (45%) had a recognized unintentional dural puncture, 1 (9%) had a combined spinal-epidural with a 24-gauge needle, and 5 (45%) had no recognized dural puncture. For 10 of the 11 cases, SDH was diagnosed at a mean of 4.1 days (range, 1–7 days) after performance of labor epidural analgesia; one case was diagnosed at 25 days. Ten (91%) of 11 cases had a second hospital stay for a mean of 2.8 days (range, 2–4 days) for observation, without further requirement for neurosurgical intervention. One case (9%) had decompressive hemicraniectomy after becoming unresponsive. The observed rate of labor epidural analgesia-associated SDH was 0.026% (11 in 42,969, approximately 1:3900), and the rate of SDH was 1.1% (5 in 437, approximately 1:87) if a recognized dural puncture occurred during epidural catheter placement.

Conclusions Subdural hematoma after labor epidural anesthesia is rare but potentially more common than historically estimated. Cases of postdural puncture headache after labor epidural anesthesia should be monitored closely for severe neurologic signs and symptoms that could herald SDH.

https://doi.org/10.1097/AAP.0000000000000455

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    Footnotes

    • The authors declare no conflict of interest.

      Funding: Dr. Lim is supported in part by a grant from the National Institutes of Health (T32GM075770).

      Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.rapm.org).