Chronic Headache and Chronic Backache Following Unintentional Dural Puncture at Delivery Room.

Study Overview
=================
Brief Summary
-----------------
he study is a telephone questionnaire. The study will include 400 women, 100 in each group. OBJECTIVE: To investigate the prevalence of chronic and chronic back pain following PDPH accidental dural puncture during epidyral analgesia for delivery. Parturients who gave birth to a normal birth and did not receive epidural anesthesia. Parturients who gave birth to a normal birth with epidural anesthesia without an unintentional dural puncture. Parturients who gave birth to a normal birth with epidural anesthesia and had an unintentional dural puncture, these women were treated conservatively. Parturients who had a normal birth with epidural anesthesia and had an unintentional dural puncture and were treated with a blood patch following PDPH.

Detailed Description
-----------------
Epidural anesthesia for pain relief during childbirth is performed in about 70% of the parturients in Shaare Zedek Medical Center. The most common complication of epidural analgesia is an unintentional dural puncture occurring in 0.4% -6% of births. Puncture causes acute headache in 70% -80% of cases. The standard treatment is the first stage of conservative treatment of painkillers and caffeine and in the absence of improvement of perform epidural blood patch 24-48 hours after the dural puncture was performed. There is no widespread support for the literature that a dural puncture with a large diameter needle is a risk factor for the development of chronic headache. For this purpose, we are interested in conducting a study to examine the prevalence of chronic headache and back pain in parturients who underwent epidural anesthesia with a dural puncture to confront parturients who underwent epidural anesthesia without puncturing the dura membrane. We know that in the years 2017-208 there were about 100 women in the hospital who had a blood patch and a similar number of women who had PDPH and were treated conservatively. From the medical records, we will randomize another 200 mothers, of which 100 were born naturally without epidural anesthesia and another 100 who gave birth to a normal birth with epidural anesthesia without dural puncture. The study will be conducted using a telephone questionnaire. The telephone questionnaire will be taken at least six months after the epidural anesthesia check if the symptoms are chronic in nature. Telephone questionnaire carried out four groups of mothers: Parturients who gave birth to a normal birth and did not receive epidural anesthesia. Parturients who gave birth to a normal birth with epidural anesthesia without an unintentional dural puncture. Parturients who gave birth to a normal birth with epidural anesthesia and had an unintentional dural puncture, these women were treated conservatively. Parturients who had a normal birth with epidural anesthesia and had an unintentional dural puncture and were treated with a blood patch following PDPH. The questionnaire will be performed after receiving informed consent from the patient. Each group will have 100 women. The questionnaire (attached as an appendix) will examine the prevalence of chronic headache and chronic back pain in these women. Our hypothesis is that in women with PDPH the incidence of chronic headache will be higher. The statistical comparison between the groups will examine demographic characteristics and characteristics related to frequency of pain, intensity, restriction of daily activity and ways to relieve pain. Comparisons between the groups for continuous variables will be done with the student t-test and data are presented as mean (standard deviation (SD)), for nonparametric tests with Mann-Whitney test and data are presented as median (interquartile range) ) [range] and for categorical values with Chi-square test and data are presented as number (percentage). A p-values <0.01 will be considered significant due to multiple comparisons. A multivariable regression analysis will be performed to evaluate factors (PDPH, epidural blood patch (EBP), chronic headache, chronic backache) associated with PPD.

Official Title
-----------------
Chronic Headache and Chronic Backache Following Unintentional Dural Puncture at Delivery Room

Conditions
-----------------
Parturient Who Underwent Epidural Anesthesia During Which an Unintentional Dural Punctur Occurred, Parturient Who Develop a Postdural Puncture Headache, Parturient Who Gave Informed Consent to Participation in the Study

Intervention / Treatment
-----------------
* Other: Epidural Blood patch.


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Parturient who underwent epidural anesthesia during which an unintentional dural punctur occurred. Parturient who develop a postdural puncture headache. Parturient who gave informed consent to participation in the study. Exclusion Criteria: Parturient without a clear dural hole during operation. Parturient who have chronic headaches or migraines. Parturient who have chronic back pain. Parturient who did not give informed consent.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
-----------------
Female

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| CONTROL<br>Parturients who gave birth to a normal birth and did not receive epidural anesthesia. | |
| Normal Epidural<br>Parturients who gave birth to a normal birth with epidural anesthesia without an unintentional dural puncture. | |
| PDPH conservative treatment<br>Parturients who gave birth to a normal birth with epidural anesthesia and had an unintentional dural puncture, these women were treated conservatively. | |
| PDPH treated with Blood Patch<br>. Parturients who had a normal birth with epidural anesthesia and had an unintentional dural puncture and were treated with a blood patch following PDPH. | Other: Epidural Blood patch.<br>* An epidural blood patch is a surgical procedure that uses autologous blood in order to close one or many holes in the dura mater of the spinal cord, usually as a result of a previous lumbar puncture. A small amount of the patient's blood is injected into the epidural space near the site of the original puncture; the resulting blood clot then patches the meningeal leak. An epidural needle is inserted into the epidural space at the site of the cerebrospinal fluid leak and blood is injected. The clotting factors of the blood close the hole in the dura.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Chronic Headache | Chronic headache development after PDPH, comparison between different groups. The diagnosis of chronic headache will be done using a questionnaire (attached as an appendix) including the Chronic Pain Grade Questionnaire (Smith et al). The main questions in the questionnaire are the incidence of headache, the severity of the headache, the duration of the problem. Disability Index is also determined by the questions about limiting pain in daily activities. | At least six months after birth. | 
| chronic Backache | Chronic backache development after PDPH, comparison between different groups. The diagnosis of chronic back pain will be done using a questionnaire (attached as an appendix) including the Low Back Pain Rating Scale (Manniche et al.). The main questions in the questionnaire are the incidence of back pain, severity of back pain, duration of the problem. Disability Index is also determined by the questions about limiting pain in daily activities. | At least six months after birth. | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
PDPH - Post Dural Puncture Headache, chronic headache, chronic backache