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Does epidural blood patches affect the placement and efficacy of future labor epidurals in obstetric patients?
Abstract Number: T 34
Abstract Type: Original Research
Background: Epidural blood patches (EBPs) are routinely performed for patients suffering from post dural puncture headaches. Recent case reports indicated that previous EBPs might decrease the success rate of future epidurals. With relatively low volume (mean 15.3ml) blood injections, a prior study demonstrated EBPs had no significant effect on subsequent epidurals. The aim of this study is to evaluate obstetric patients with a history of larger volume lumbar EBPs to determine the effects on subsequent labor epidurals.
Methods: Upon IRB approval, 730 women who had EBPs at the Brigham and Women’s Hospital (2000-2012) were identified; 400 charts have been reviewed and data collection has been completed on 22 patients who received neuraxial techniques for a subsequent labor and delivery after EBP. Epidural placement and function information were retrieved and analyzed.
Results: Seventeen patients received epidural placements, 3 had combined spinal-epidurals and 2 had spinals. Patients who had only epidural placements were used in the data analysis. An average of 1.8 attempts was made on the original placements, resulting in 10 dural punctures. Seven intrathecal catheters were placed. All 17 patients had EBPs with an average of 26ml of autologous blood injected. Two patients received repeat EBPs with an average of 25ml of blood. All blood patches were achieved with 1 attempt and no complications were noted. For subsequent epidural placements, there were 1.3 attempts on average. Labor epidurals were performed in all 17 patients; 1 patient had 2 subsequent deliveries with epidurals. Level of placement included 3 at L2-3, 8 at L3-4 and 5 at L4-5. Time from placement to first recorded time of comfort was averaged to be 28 min. Mean duration of epidural time was 253 min. Successful epidural placements were defined as epidurals that resulted in good analgesia without need for replacement. Two epidurals needed to be replaced in separate patients. One was due to a one-sided block and the other was due to no identifiable dermatomal level. Subsequent epidurals provided good analgesia without complications or need for further adjustment. The overall epidural success rate was 89%. Three patients required eventual cesarean deliveries. No complications were noted after epidural placements.
Conclusion: EBPs do not appear to affect the placement and efficacy of subsequent epidurals in obstetric patients.
Note: This abstract contains partial data for the purpose of submission. Data collection and analysis of the entire data set will be completed prior to the SOAP meeting. We also plan to match the study group with a control group who had two interval epidurals without EBP.
Hebl JR, et al. Epidural anesthesia and analgesia are not impaired after dural puncture with or without epidural blood patch. Anesth Analg 1999;89:390.
Ong BY, et al. Impaired epidural analgesia after dural puncture with and without subsequent blood patch. Anesth Analg 1990;70:76