The influence of timing on the effectiveness of epidural blood patches in parturients

Abstract

BackgroundPostdural puncture headache is common in parturients following lumbar puncture. If headache is severe and persistent, an epidural blood patch is recommended. In this paper we reviewed the efficacy of epidural blood patches over a 13-year period at two hospitals in Finland with a particular emphasis on its timing. MethodsThe hospitals’ databases were searched to identify parturients who underwent an epidural blood patch from March 1998 to June 2011. Parturients’ records were reviewed to establish the characteristics and associated symptoms of headache and the effectiveness of the epidural blood patch. ResultsA total of 129 parturients received 151 epidural blood patches. These followed spinal (n=49), epidural (n=47) or combined spinal–epidural blocks (n=33). The success rate of the first procedure was 89%, with permanent relief in 76%. The first procedure provided permanent relief of postdural puncture headache for 86% of 78 patients having the procedure after 48h, compared to 65% of 37 patients when it was performed between 24 and 48h, and 50% of 14 patients with the procedure within the first 24h after dural puncture (P=0.003). A second procedure was performed for 22 parturients due to incomplete relief (n=5) or recurrent symptoms (n=17); all had complete resolution of symptoms. ConclusionsEpidural blood patch performed later than 48h following lumbar puncture or accidental dural puncture is effective in parturients with postdural puncture symptoms. The recurrence rate of symptoms after an initially successful epidural blood patch is high, and therefore patients should be provided with counselling and contact information.