Neuraxial analgesia (most commonly continuous epidural or combined spinal epidural) is the
most effective modality available for pain relief during labor. Accidental dural puncture
(ADP) with a large bore epidural needle and the resulting post-dural puncture headache (PDPH)
is one of the most significant sources of anesthesia-related morbidity in parturients.
Epidural blood patch (EBP) is the gold standard for treatment of PDPH, and although almost
always effective, can result in another ADP, as well as low back pain and lower extremity
pain. For this reason, effective measures to prevent PDPH when ADP occurs would be highly
valuable. One small study in which 50 women were randomly allocated to receive 2 epidural
injections of morphine or saline, demonstrated a beneficial effect of epidural morphine in
decreasing the incidence of PDPH.
This study aims to determine the efficacy of 2 doses of neuraxial (either epidural (EPID) or
intrathecal) preservative-free morphine (PFM) to prevent headache after ADP in parturients.