A survey of post-dural puncture headache management practices within a South African academic department

Abstract

Background: Post-dural puncture headache (PDPH) is a common consequence of neuraxial anaesthesia; especially among parturients, in whom it is associated with maternal morbidity, prolonged hospital stay and increased healthcare costs. Although international guidelines are available for PDPH management, variable management practices exist. There are no published studies which document current practices, or available guidelines, with respect to PDPH management in South Africa. This study aimed to describe PDPH management practices within the University of the Witwatersrand (Wits) Department of Anaesthesiology, which may assist in future local guideline or protocol development.
Methods: An electronic questionnaire was distributed to the Wits Department of Anaesthesiology. The survey instrument was developed following a literature review targeting recent evidence-based PDPH management guidelines, including the United Kingdom-based Obstetric Anaesthetists’ Association (OAA) guidelines from 2018. Thereafter it was reviewed for content and face validity. Participant responses were compared to the OAA guidelines, which were considered the standard of practice. A related score was determined and correlations with demographic variables were assessed.
Results: Participants’ practice with respect to conservative management strategies and the performance of epidural blood patches (EBPs) was in keeping with the OAA guidelines. This is despite a lack of available departmental guidelines and limited provider experience with performing these procedures. Of the participants, 96% perceived they would benefit from the institution of formal guidelines.
Conclusion: PDPH management practices among anaesthetists within the Wits circuit are variable. Despite limited experience in treating PDPH, these practices are generally consistent with current international guidelines. The development and institution of formal guidelines for the management of PDPH are recommended, as well as continuing medical education of staff, to improve patient outcomes.