Neuraxial morphine does not have a protective effect on headache after unintentional dural puncture.

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• Molly E Brinser, David L Seng, Gordon L Mandell, Jonathan Waters, Patricia L Dalby, and Grace Lim.
• Department of Anesthesiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of the University of Pittsburgh Medical Center, 300 Halket Street Suite 3510, Pittsburgh, PA 15213, USA.
• J Clin Anesth. 2019 Feb 1; 52: 58-62.

Study ObjectiveTo examine the relationship between neuraxial morphine exposure after unintentional dural puncture and the risk for postdural puncture headache in obstetric patients.DesignRetrospective cohort study.SettingObstetrical unit at a tertiary care referral center.PatientsParturients receiving labor epidural analgesia with recognized unintentional dural puncture.InterventionsCases in which neuraxial morphine was given for any reason were compared to cases in which it was not for the outcome of postdural puncture headache.MeasurementsDevelopment of postdural puncture headache, headache severity, number of epidural blood patches, hospital length of stay.Main ResultsOf the 80 cases that were included, 38 women received neuraxial morphine and 42 did not. There was no significant difference in the incidence of headache between the two morphine groups (Headache present: Morphine: 27/56 [48.2%], No morphine: 29/56 [51.8%]; Headache free: Morphine: 11/24 [45.8%], No morphine: 13/24 [54.2%], P = 0.84). There was no difference in the need for epidural blood patch (Morphine: 24/42 [57.1%], No morphine: 18/38 [47.4%], P = 0.50) and headache severity (mean headache pain score: Morphine: 7.9 ± 1.8 vs. No morphine: 7.3 ± 2.4, P = 0.58). Hospital length of stay was higher in the morphine group (4.4 ± 2.9 days vs. 3.0 ± 1.5 days respectively, P = 0.008). Using logistic regression, morphine did not affect headache risk after controlling for covariates (morphine vs. no morphine: adjusted OR 1.24 [0.75]; P = 0.72; pre-eclampsia vs. no pre-eclampsia: adjusted OR 0.56 [0.41], P = 0.42; cesarean vs. normal spontaneous vaginal delivery: adjusted OR 0.97 [0.67]; P = 0.96).ConclusionIn cases of unintentional dural puncture, exposure to neuraxial morphine for any reason may not be protective against the risk of postdural puncture headache. Although an overall protective effect of neuraxial morphine was not observed in this study, its role in specific subsets of patients remains to be investigated.Copyright © 2018 Elsevier Inc. All rights reserved.

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