Unsuccessful epidural blood patch is associated with higher lumbar levels, shorter time between puncture & patch, and with patients with migraine history.

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• Anil Gupta, Marc Van de Velde, Anders Magnuson, Christian von Heymann, Emilia Guasch, Seppo Alahuhta, Frédéric J Mercier, Schyns-van den BergAlexandra M J VAMJVDepartment of Anesthesiology, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands; Department of Anesthesiology, Leiden University Medical Centre, Leiden, the Netherlands., and European Practices in the Management of Accidental Dural Puncture in Obstetrics Investigators.
• Department of Perioperative Medicine and Intensive Care and Institution of Physiology and Pharmacology, Karolinska Hospital and Karolinska Institutet, Stockholm, Sweden. Electronic address: anil.gupta@regionstockholm.se.
• Br J Anaesth. 2022 Nov 1; 129 (5): 758766758-766.

BackgroundEpidural blood patch is commonly used for management of post-dural puncture headache after accidental dural puncture. The primary aim was to determine factors associated with failed epidural blood patch.MethodsIn this prospective, multicentre, international cohort study, parturients ≥18 yr receiving an epidural blood patch for treatment of post-dural puncture headache were included. Failed epidural blood patch was defined as headache intensity numeric rating scale (NRS) score ≥7 in the upright position at 4, 24, or 48 h, or the need for a second epidural blood patch, and complete success by NRS=0 at 0-48 h after epidural blood patch. All others were considered partial success. Multinominal logistic regression was used for statistical analyses with P<0.01 considered statistically significant.ResultsIn all, 643 women received an epidural blood patch. Complete data to classify failure were available in 591 (91.9%) women. Failed epidural blood patch occurred in 167 (28.3%) patients; 195 (33.0%) were completely successful and 229 (38.7%) partially successful. A total of 126 women (19.8%) received a second epidural blood patch. A statistically significant association with failure was observed in patients with a history of migraine, when the accidental dural puncture occurred between lumbar levels L1/L3 compared with L3/L5 and when epidural blood patch was performed <48 h compared with ≥48 h after accidental dural puncture. In patients having radiological investigations, three intracranial bleeds were diagnosed.ConclusionsFailed epidural blood patch occurred in 28.3% of women. Independent modifiable factors associated with failure were higher lumbar level of accidental dural puncture and short interval between accidental dural puncture and epidural blood patch. A history of migraine was associated with a higher risk of second epidural blood patch.Clinical Trial RegistrationNCT02362828.Copyright © 2022. Published by Elsevier Ltd.

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