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Comparison of Epidural Blood Patches Performed with Blind Loss of Resistance Technique versus Fluoroscopic Guidance for Postdural Puncture Headache in Parturients
Abstract Number: GM-1
Abstract Type: Original Research
INTRODUCTION: Epidural blood patch (EBP) is an effective therapeutic treatment for postdural puncture headache (PDPH). Traditionally, EBP has been performed using a blind loss of resistance (BLOR) technique. However, fluoroscopy has become increasingly utilized in the last decade for EBP placement. The objective of this retrospective study was to compare the efficacy and safety profiles of EBP performed using a BLOR technique and those using a fluoroscopic-guided (FLUORO) technique.
METHODS: All patients, age ≥ 18 years, who underwent a BLOR EBP at Brigham and Women’s Hospital from January 1, 2009 to August 30, 2011 or a FLUORO EBP at Mayo Clinic from January 1, 2005 to December 1, 2011 for postpartum PDPH treatment, were retrospectively identified. Only the patients’ first EBP was analyzed. Procedural details and outcome data including patient demographics, date and time of neuraxial placement, date and time of EBP, volume of blood injected, continued or recurrence of PDPH, need for repeat EBP, and complications were collected.
RESULTS: A total of 89 patients underwent BLOR EPB and 68 patients underwent FLUORO EBP were reviewed. Body Mass Index (BMI) was lower in the BLOR group (30.6 ± 5.7 vs 33.0 ± 7.1; p=0.018). The mean number of hours from neuraxial placement to EBP was similar between the BLOR and FLUORO groups (65.5 ± 33.8 vs 71.8 ± 42.4; p=0.338). A higher volume of blood was injected in the BLOR group (22 ± 7 vs 18 ± 4 ml; p<0.001). Continued or recurrent headache occurred in 42 (47.2%) patients in the BLOR group compared to 12 (17.6%) in the FLUORO group (OR=4.2; 95% CI 2.0 to 8.8; p<0.001). Twenty-four (27.0%) patients in the BLOR group underwent a repeat EBP compared to 6 (8.8%) in the FLUORO group (OR=3.8; 95% CI 1.5 to 10.0; p=0.006). There was one EBP-related complication in each group. Both complications were minor and achieved complete resolution.
DISCUSSION: This is a pilot retrospective study comparing EBP performance using BLOR technique to FLUORO technique. The number of patients experiencing continued headache or a recurrence of headache after initial relief was higher in the BLOR group compared to the FLUORO group. This result could be from the BMI difference between the groups. We are planning on future paired sample analysis to control for this confounding factor upon additional sample data collection. Repeat EBP rate was higher in the BLOR group, which could be attributed to practice style differences between institutions such as willingness to perform repeat EBP, or possible scheduling or cost obstacles for EBP performance. There was no difference in complications rates or severity. A carefully designed prospective study may better illustrate the differences between these techniques.
1. Saffa-Tisseront, et al. Anesthesiology 2001;95:334.
2. Kawaguchi, et al. J Anesth 2011;25:450.