title: Prophylactic vs therapeutic blood patch for obstetric patients with accidental dural puncture--a randomised controlled trial.
abstract: Epidural blood patch is a standard treatment for obstetric patients experiencing a severe post-dural puncture headache. Patients who sustained an accidental dural puncture during establishment of epidural analgesia during labour or at caesarean delivery were randomly assigned to receive a prophylactic epidural blood patch or conservative treatment with a therapeutic epidural blood patch if required. Eleven of 60 (18.3%) patients in the prophylactic epidural blood patch group developed a post-dural puncture headache compared with 39 of 49 (79.6%) in the therapeutic epidural blood patch group (p < 0.0001). A blood patch was performed in 36 (73.4%) of patients in the therapeutic group. The number of patients who needed a second blood patch did not differ significantly between the two groups: 6 (10.0%) for prophylactic epidural blood patch and 4 (11.1%) for therapeutic epidural blood patch. We conclude that prophylactic epidural blood patch is an effective method to reduce the development of post-dural puncture headache in obstetric patients.
authors.affiliation: Department of Anesthesia, Rutgers, The State University of New Jersey- Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Stein
authors.forename: S
authors.initials: S
authors.lastname: Cohen
authors.forename: M A
authors.initials: MA
authors.lastname: Mohiuddin
authors.forename: V
authors.initials: V
authors.lastname: Dombrovskiy
authors.forename: I
authors.initials: I
authors.lastname: Lowenwirt
mesh_terms: D000293:Adolescent; D000328:Adult; D000773:Anesthesia, Obstetrical; D017217:Blood Patch, Epidural / Q000379:methods*; D002585:Cesarean Section; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D007743:Labor, Obstetric; D010147:Pain Measurement; D010298:Parity; D051299:Post-Dural Puncture Headache / Q000517:prevention & control*; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult