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An Intrapartum Epidural Blood Patch
Abstract Number: RF2BB-123
Abstract Type: Case Report Case Series
Introduction: Post-dural puncture headache (PDPH) is a common unintentional consequence of epidural placement, spinal anesthesia, and therapeutic lumbar puncture. Treatment includes autologous lumbar epidural blood patch (EBP). This case presents a unique clinical situation where a patient required a labor epidural two hours after receiving a therapeutic epidural blood patch for a post-dural puncture headache.
Case: 32 year old G3P2 at 37 weeks gestation with PMH of cervical insufficiency presents with contractions and headache. Two days prior, patient underwent an uneventful cerclage removal under epidural anesthesia. During placement of the epidural, dural puncture was inadvertently obtained at L3-4 interspace and a second attempt at L2-3 interspace was uneventful. Patient’s symptoms were consistent with post-dural puncture headache. Discussion with obstetricians revealed that the patient was not in active labor. A blood patch was performed with 14 mls of autologous blood and her headache was relieved. One hour after the blood patch, her cervical examination changed and she was in active labor and subsequently requested an epidural for labor analgesia. The epidural was placed two hours after the blood patch without complication. Patient had SVD and epidural catheter was removed postpartum.
Discussion: PDPH generally present with severe headaches that are usually orthostatic and EBP is the treatment of choice. Fresh blood in the epidural space comes with limitations to immediate neuraxial placement and efficacy that include: inconsistent analgesia profile, possible arachnoidits and possible high spinal2. We report one of the shortest time interval between epidural blood patch and labor analgesia.
1. Chestnut, D. H. (2014). Chapter 31, 713-738
2. Leivers D 1990. Anesthesiology; 73: pp. 1287-1289