More on CSE

Is dural puncture worth it? It is argued that CSE for labour instead of an epidural alone reduces the risk of accidental dura puncture, possibly because the identification of CSF through the spinal needle can confirm that the epidural needle tip is indeed in the epidural space. But what of the inherent risk of intentional dural puncture in causing headache, albeit with a small gauge non-cutting needle. Well, at my august institution, data from all patient who received neuraxial blocks in labour of for caesarean allows comarison between 1673 epidurals, 1620 CSE, and 1452 spinals. There were 8, 15 and 16 headaches respectively. 2,1 and 3 respectively were blood patched. On these figures, the number needed to harm (with postdural puncture headache) if doing CSE instead of plain epidural is 223, but applying 95% confidence intervals the NNH could be 87. It is back to the old 1% headache chance. And the question is: is 1 % for headache low enough?