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Retrospective review of blood patch placement rates for post-dural puncture headaches by neuraxial anesthetic technique type in an academic labor and delivery unit
Abstract Number: SAT-30
Abstract Type: Original Research
Background: Post-dural puncture headache (PDPH) is one of the more common complications from use of neuraxial techniques in the parturient. In severe cases, epidural blood patch may be required to treat PDPH. In addition to the conventional epidural technique (EPL), other neuraxial techniques for labor analgesia or cesarean delivery involve a dural puncture: single shot spinal injection (SSS), combined spinal epidural (CSE), and, most recently, dural puncture epidural (DPE) techniques. The comparative rates of complications for each have not been well established.
Objective: To review the rate of epidural blood patch procedures by neuraxial technique type in patients receiving care in the labor and delivery unit.
Methods: Retrospective chart review of neuraxial anesthetics was performed at a large academic center’s labor and delivery unit. Data available on all patients over an 18-month span who received care from the obstetric anesthesia team was gathered from the institution’s electronic medical record reporting tool as well as a manually maintained case followup database. We computed risk ratios for each technique compared to EPL as the reference with 95% confidence intervals and p-values using Fisher’s exact test (SAS 9.4, Cary NC).
Results: During the review period, 4288 EPLs, 1304 SSSs, 592 CSEs, and 243 DPEs were performed. Among those who received neuraxial anesthesia, 38 patients developed PDPH requiring at least one blood patch. Compared to EPL, the relative risk ratio (RR) for SSS was 0.76 (95% confidence interval [CI] 0.32-1.85, p=0.16), CSE was 0.84 (95% CI 0.26-2.77, p=1.0), and DPE was 2.03 (95% CI 0.62-6.67, p=0.20).
Conclusions: The rate of blood patch use in patients receiving neuraxial techniques involving a small needle dural puncture are low and not significantly higher than the rates for an EPL technique. The SSS, CSE and DPE techniques should be offered for their salient advantages with minimal concern for increasing the rate of PDPH requiring blood patch.