Understanding Dural Puncture Injuries
What the latest research tells us
What is an Accidental Dural Puncture?
An accidental dural puncture happens when the epidural needle unintentionally passes through the dura. It's a known risk of every labour epidural, and a growing body of research suggests its consequences are more serious, and longer-lasting, than the field long assumed.
Complications from Dural Punctures
Most dural punctures announce themselves within days. Roughly 70% to 80% of patients develop a severe positional headache, in 90% of cases within 72 hours, that can leave a new mother flat in bed, extend her hospital stay, and interfere with caring for her newborn.
Sachs A, Smiley R. Post-dural puncture headache: the worst common complication in obstetric anesthesia. Seminars in Perinatology. 2014;38:386-394.
Many Dural Punctures go Unrecognized
Not every dural puncture is caught at the time it happens. In a 10-year audit of 12,981 labor epidurals, roughly a third of all dural punctures were never recognized during the procedure itself and only came to light when the patient later developed symptoms.
“Unrecognized dural punctures comprised a third of all dural punctures, and systematic post-neuraxial follow-up is essential to identify these women.”
Eley et al., Journal of Anesthesia, 2022
New Research is challenging the idea that these injuries are self limiting
Post-dural puncture headache (PDPH) has traditionally been described as self-limiting, but recent long-term studies are calling that into question.
A five-year prospective follow-up found that chronic pain after a dural puncture is a prolonged condition.
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At five years, chronic headache affected 21.4% of women with PDPH who had no blood patch and 20.4% of those who did, versus 0.9% of women who had no labor epidural.
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Chronic backache affected roughly 16 to 21% of the PDPH groups versus about 1% who had no labor epidural.
“This study demonstrates that chronic pain after an unintended dural puncture is a prolonged condition with substantial functional consequences, challenging its traditional characterization as a transient complication.” Weiss et al., International Journal of Obstetric Anesthesia, 2025
A separate cohort study found that women with PDPH had markedly higher rates of postpartum depression (52.3% vs 11.2%) and post-traumatic stress disorder (12.8% vs 0.4%) than women with uncomplicated epidurals, and breastfed less often. Orbach-Zinger S, et al. European Journal of Anaesthesiology. 2021.
