///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

Epidural anesthesia for postpartum tubal ligation and subsequent blood patch for a patient with postdural puncture headache

Abstract Number: FCC-410
Abstract Type: Case Report Case Series

Hsi Chiao MD PhD1 ; Robert S Ackerman MD2; Brenda K Anyaehie MD3; Hsi Chiao MD PhD4

Introduction:

Postdural puncture headache (PDPH) is a major complication of neuraxial anesthesia that can occur with inadvertent dural puncture during epidural anesthesia. In addition to severe headache, patient may experience nausea, neck stiffness, and vision changes. A epidural blood patch (EBP) is considered the definitive treatment for severe PDPH with a success rate of 61-98% (1). A scheduled case, such as postpartum bilateral tubal ligation (BTL) would be cancelled if the patient has severe PDPH without the treatment. Our patients desire postpartum tubal ligations, however, an EBP prior to a BTL may delay the case or prolong their hospital stays. We discuss the successful treatment of PDPH with a post-operative EBP via an epidural catheter that was used for her postpartum BTL.

Case:

A 31 years old female (G5P4A1) with severe positional headache and photophobia presented on postpartum day one from vaginal delivery for postpartum BTL. Patient had an inadvertent dural puncture during her epidural placement by a 17 gauge epidural needle two days ago. Her headache and photophobia occurred one day after the incident and did not have any improvement with hydration, caffeine beverages, and oral pain medications. Despite the suggestion to postpone her surgery by obstetric team, patient insisted to have the BTL at that time. Therefore plan was made to do an epidural anesthesia for her BTL and leave the epidural catheter in situ to perform EBP post operatively. An epidural catheter was placed one level below the site of dural puncture and was dosed with 20 ml 2% lidocaine to achieve surgical level for BTL. After surgery, the epidural catheter was left in situ and taped in aseptic fashion. After her epidural level was regressed, patient was assessed for PDPH again prior to EBP. Twenty milliliters autologous blood was drawn using strict aseptic fashion and slowly injected into epidural space through the epidural catheter. Patient had complete relief of her headache and photophobia and the end of EBP and discharged home as scheduled.

Conclusion:

Accidental dural puncture can occur during labor epidural placement and cause PDPH. Although there are conservative treatments, EBP is proved to be the definitive treatment for PDPH. Studies have shown that prophylactic EBP did not decrease the need for therapeutic EBP (2) and several studies suggested increased successful rate if give EBP after 24 hours of dural puncture (3). Our anesthesia management for this patient has suggested that there is no need to cancel the postpartum BTL for patients with PDPH. The epidural anesthesia may serve not only for surgery, but also for EBP post-operatively. This will shorten patients’ hospital stay and increase the satisfactions by patients and the obstetric team.

Reference:

1. Bucklin BA et al. Anesthesiology 2005; 103:645-653

2. Scavone BM et al. Anesthesiology 12 2004 vol.101, 1422-1427

3. Kokki M et al. International Journal of Obstetric Anesthesia 2013;22:303-9

SOAP 2019