[Epidural blood patch, never too late].
Long lasting postural puncture headache secondary to an unintentional dural puncture (UDP) during epidural anaesthesia (EA) or following deliberate dural puncture for spinal anaesthesia, and neurological or neuroradiological examination, is becoming unusual. Placing the bevel of Tuohy needle parallel to the longitudinal axis of the dural cylinder when searching for epidural space, and in the later cases, widespread use of small diameter, atraumatic needles, have decreased both its incidence and severity. Furthermore, in the absence of any contraindication, patients suffering from such troubles are now quite systematically offered a curative epidural blood patch (EBP) whose effectiveness is documented. Authors report an original case of a fainthearted patient who underwent caesarean section under EA when she was 31-year-old, and whose disabling painful symptoms related to a UDP were successfully relieved by one EBP that she ended to accept more than seven years later. On the occasion of a short literature review, physiopathology and management are debated.
Raffin
L
L
Clinique Les Martinets, 97, avenue Albert-1(er), 92500 Rueil-Malmaison, France. lionel.raffin@wanadoo.fr
Batiste
C
C
Noël
D
D
Serbouh
A
A
D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical; D017217:Blood Patch, Epidural; D002585:Cesarean Section; D005260:Female; D006261:Headache / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D011247:Pregnancy; D013129:Spinal Puncture / Q000009:adverse effects