title: Efficacy of a prophylactic epidural blood patch in preventing post dural puncture headache in parturients after inadvertent dural puncture.
abstract: BACKGROUND
  Postdural puncture headache (PDPH) occurs in up to 80% of parturients who experience inadvertent dural puncture during epidural catheter placement. The authors performed a randomized double blind study to assess the effect of prophylactic epidural blood patch on the incidence of PDPH and the need for therapeutic epidural blood patch.
  
  
  METHODS
  Sixty-four parturients who incurred inadvertent dural puncture were randomized to receive a prophylactic epidural blood patch with 20 ml autologous blood (prophylactic epidural blood patch group) or a sham patch (sham group). Subjects were evaluated daily for development of PDPH for a minimum of 5 days after dural puncture. Those who developed a PDPH were followed daily for a minimum of 3 days after resolution of the headache. Subjects with moderate headaches who reported difficulties performing childcare activities and all those with severe headaches were advised to receive a therapeutic epidural blood patch.
  
  
  RESULTS
  Eighteen of 32 subjects in each group (56%) developed PDPH. Therapeutic blood patch was recommended in similar numbers of patients in each group. The groups had similar onset time of PDPH, median peak pain scores, and number of days spent unable to perform childcare activities as a result of postural headache. The median duration of PDPH, however, was shorter in the prophylactic epidural blood patch group.
  
  
  CONCLUSIONS
  A decrease in the incidence of PDPH or the need for criteria-directed therapeutic epidural patch was not detected when a prophylactic epidural blood patch was administered to parturients after inadvertent dural puncture. However, prophylactic epidural blood patch did shorten the duration of PDPH symptoms.
authors.affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, USA. bscavone@nmff.org
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Scavone
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Wong
authors.forename: John T
authors.initials: JT
authors.lastname: Sullivan
authors.forename: Edward
authors.initials: E
authors.lastname: Yaghmour
authors.forename: Saadia S
authors.initials: SS
authors.lastname: Sherwani
authors.forename: Robert J
authors.initials: RJ
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D017217:Blood Patch, Epidural; D004311:Double-Blind Method; D005260:Female; D006261:Headache / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D011446:Prospective Studies; D016896:Treatment Outcome