Headache prevention following accidental dural puncture in obstetric patients.
OBJECTIVE
To evaluate the efficacy of a prophylactic saline patch and a prophylactic blood patch in prevention of headache following accidental dural puncture in obstetric patients.


METHODS
Prospective, randomized, single-blind study on dural puncture headache occurrence and cessation.


METHODS
Inpatient obstetric unit at a metropolitan medical center.


METHODS
Seventy-four inpatients who underwent vaginal delivery or cesarean section following accidental dural puncture during administration of epidural anesthesia for labor and delivery.


METHODS
Group 1 (n = 24), the control group, received fluids and analgesics. Group 2 (n = 30) received prophylactic epidural saline (40 to 60 ml) through the epidural catheter following completion of the obstetric procedure. Group 3 (n = 20) received autologous blood (15 ml) via epidural catheter following completion of the obstetric procedure.


RESULTS
In Group 1, 21 of 24 patients (87.5%) developed headaches, with conservative management. In Group 2, 20 of 30 patients (66.7%) developed headaches, and in Group 3, 1 of 20 patients (5%) developed a headache.


CONCLUSIONS
The results of this study suggest that the administration of a prophylactic epidural blood patch is highly effective in the prevention of headaches following dural puncture, with headache frequency reduced from 87.5% to 5%.
Trivedi
N S
NS
Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY.
Eddi
D
D
Shevde
K
K
D000700:Analgesics / Q000627:therapeutic use; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D017217:Blood Patch, Epidural; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D005440:Fluid Therapy; D006261:Headache / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007268:Injections, Epidural; D011247:Pregnancy; D011446:Prospective Studies; D016037:Single-Blind Method; D012965:Sodium Chloride / Q000627:therapeutic use
D000700:Analgesics; D012965:Sodium Chloride