To the Editor:
We appreciate the editorial views of Drs. Flood and Li in their article, “A Terrible Headache in Obstetric Anesthesia,” as they emphasized the need for careful evaluation of any headache after epidural anesthesia to rule out rare but possible subarachnoid hemorrhage.1The authors make the statement that “the incidence of postdural puncture headache is approximately 1%, regardless of whether a spinal or epidural technique was performed.” We believe the current incidence of inadvertent dural puncture after epidural anesthesia in labor and delivery is much less than the 1% they quote.2Katircioglu et al. reported an incidence of 0.13% in their large obstetric anesthesia practice.3Gleeson reported an incidence of 0.19% from multiple centers that performed more than 1,000 epidurals annually.4We also found and still maintain an incidence of approximately 0.16% in our own large obstetric anesthesia practice.5We therefore do not agree that the 1% incidence of inadvertent dural puncture quoted in this editorial1,2accurately represents the results of current large obstetrical anesthesia practices. Instead, we believe an occurrence rate of less than 0.2% would be more representative of today's anesthesia practice.