Headache prevention following accidental dural puncture in obstetric patients

J Clin Anesth. Jan-Feb 1993;5(1):42-5. doi: 10.1016/0952-8180(93)90086-t.

Abstract

Study objective: To evaluate the efficacy of a prophylactic saline patch and a prophylactic blood patch in prevention of headache following accidental dural puncture in obstetric patients.

Design: Prospective, randomized, single-blind study on dural puncture headache occurrence and cessation.

Setting: Inpatient obstetric unit at a metropolitan medical center.

Patients: Seventy-four inpatients who underwent vaginal delivery or cesarean section following accidental dural puncture during administration of epidural anesthesia for labor and delivery.

Interventions: Group 1 (n = 24), the control group, received fluids and analgesics. Group 2 (n = 30) received prophylactic epidural saline (40 to 60 ml) through the epidural catheter following completion of the obstetric procedure. Group 3 (n = 20) received autologous blood (15 ml) via epidural catheter following completion of the obstetric procedure.

Measurements and main results: In Group 1, 21 of 24 patients (87.5%) developed headaches, with conservative management. In Group 2, 20 of 30 patients (66.7%) developed headaches, and in Group 3, 1 of 20 patients (5%) developed a headache.

Conclusions: The results of this study suggest that the administration of a prophylactic epidural blood patch is highly effective in the prevention of headaches following dural puncture, with headache frequency reduced from 87.5% to 5%.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Analgesics / therapeutic use
  • Anesthesia, Epidural / adverse effects*
  • Anesthesia, Obstetrical / adverse effects*
  • Blood Patch, Epidural*
  • Dura Mater / injuries*
  • Female
  • Fluid Therapy
  • Headache / etiology
  • Headache / prevention & control*
  • Humans
  • Incidence
  • Injections, Epidural
  • Pregnancy
  • Prospective Studies
  • Single-Blind Method
  • Sodium Chloride / therapeutic use

Substances

  • Analgesics
  • Sodium Chloride