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Successful Epidural Analgesia in a Patient with Recent Epidural Blood Patch
Abstract Number: S-31
Abstract Type: Case Report/Case Series
We report a patient who had successful epidural analgesia for labor six days after receiving an epidural blood patch. A 40-year-old woman, with no significant past medical history, presented for external cephalic version at 37.3weeks gestation. Initial attempts at version by her obstetrician were unsuccessful. Epidural anesthesia was requested to facilitate external cephalic version. During epidural placement with a 17 g Touhy needle, an inadvertent dural puncture occurred at L3/4. This needle was withdrawn and an epidural catheter was placed at the L2/3 space. Epidural anesthesia was provided with 15 mL of Lidocaine 2% to obtain a T6 level. External cephalic version was successful.
Two days after the version, the patient presented to labor and delivery with a postdural puncture headache. An epidural blood patch was performed at the L3/4 space and with 25 mL or sterile blood. Her headache symptoms resolved, and she was discharged home.
Six days after her blood patch, our patient presented in labor. An epidural catheter was placed at the L2/L3 space using a 17 g Touhy and loss of resistance technique with saline. Interestingly, a very small blood clot came out of the Touhy needle when in the epidural space. Successful analgesia was provided using our routine medications (Epidural bolus with 10 mL of bupivacaine 0.25%, followed by PCEA with bupivacaine 0.625% and fentanyl 2 mcg/mL at 7 mL/hour with 7 mL demand bolus every 7 minutes).
Higher success rates have been reported for external cephalic version with epidural anesthesia.(1) With an increasing use of epidural anesthesia for external cephalic version, obstetric anesthesiologists may see an increasing number of these patients with inadvertent dural puncture requiring an epidural blood patch while they are still pregnant. Previous studies have shown successful epidural analgesia after an epidural blood patch during previous pregnancies (mean time interval 33 months). (2) In conclusion, we present the successful use of epidural analgesia for labor in a patient with a recent epidural blood patch.
1. Yoshida M, Matsuda H, Kawakami Y, Hasegawa Y, Yoshinaga Y, Hayata E, et al. Effectiveness of epidural anesthesia for external cephalic version (ECV). Journal of perinatology : official journal of the California Perinatal Association. 2010;30(9):580-3.
2. Hebl J, Horlocker T, Chantigian R, Schroeder D. Epidural Anesthesia and Analgesia Are Not Impaired After Dural Puncture With or Without Epidural Blood Patch. Anesth Analg. 1999;89:390-4.