Abstract
The use of epidural blood patches has become standard treatment for postdural puncture
headache. Two cases suggest that there may occasionally be incomplete resorption of
the blood patch, resulting in scarring in the epidural space that can be visualised
using postpartum contrast injection and fluoroscopy. Both patients had a previous
caesarean delivery during which they had suffered inadvertent dural punctures followed
by epidural blood patches. When subsequently presenting for repeat caesarean delivery,
both had inadequate epidural anaesthesia. Epidural insertion was then repeated, resulting
in successful anaesthesia in one patient but a total subdural block with delayed apnoea
and unconsciousness in the other. Distortion of epidural anatomy by fibrosis was considered
to be a possible cause.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to International Journal of Obstetric AnesthesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Treatment of postspinal headache.Anesthesiology. 1960; 21: 565-566
- Meningeal (postdural) puncture headache, unintentional dural puncture, and the epidural blood patch: a national survey of United States practice.Reg Anesth Pain Med. 2009; 34: 430-437
- Epidural injection of autologous blood for postlumbar-puncture headache. II. Additional clinical experiences and laboratory investigation.Anesth Analg. 1972; 51: 226-232
- Magnetic resonance imaging of extradural blood patches. appearances from 30 min to 18h.Br J Anaesth. 1993; 71: 182-188
- Epidural blood patch.Anaesthesia. 1985; 40: 381
- Restricted spread of analgesia following epidural blood patch. Case report with a review of possible complications.Anaesthesia. 1983; 38: 481-484
- Atlas of epidurograms: epidural blocks investigated.Informa Healthcare, London, UK1998
Collier CB. Epidural anaesthesia: images, problems, solutions. London UK: Hodder Arnold; in press.
- Epidural injection of autologus blood for post lumbar puncture headache.Anesth Analg. 1973; 52: 218-219
- Successful epidural anesthesia following epidural blood patch.Anesth Analg. 1978; 57: 272-273
- Regional analgesia following epidural blood patch.Anesth Analg. 1975; 54: 634-636
- Epidural anesthesia and analgesia are not impaired after dural puncture with or without epidural blood patch.Anesth Analg. 1999; 89: 390-394
- Extradural blood patch after an intradural injection.Anaesthesia. 1988; 43: 251
- Subarachnoid spread of epidural local anaesthetic following dural puncture.Anaesthesia. 1988; 43: 671-674
- Epidural bubbles as a cause of incomplete analgesia during epidural anesthesia.Anesth Analg. 1987; 66: 679-683
- Total spinal or massive subdural block.Anaesth Int Care. 1982; 10: 92
- Collapse after epidural injection following inadvertent dural perforation.Anesthesiology. 1982; 57: 427-428
- The problem of subdural placement in myelography.Radiology. 1962; 79: 91-95
- The effect of epidural saline injection on analgesic level during combined spinal and epidural anesthesia assessed clinically and myelographically.Anesth Analg. 1997; 85: 1097-1100
- Bacteraemia after placental separation during caesarean delivery.Obstet Gynecol. 1996; 87: 779-784
Article info
Publication history
Published online: September 15, 2011
Accepted:
July 18,
2011
Presented in part at the Obstetric Anaesthetists Association Meeting, Edinburgh, May 2011.Identification
Copyright
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
