Unintentional Dural Puncture and Prophylactic Epidural Blood Patch in Obstetrics

Does postdural puncture headache left untreated lead to subdural hematoma? Case report and review of the literature

“…Some authors have suggested that prophylactic epidural blood patch may reduce the incidence of subsequent PDPH to 5%-21%. [59][60][61] However, Scavone et al 62 showed recently that prophylactic epidural blood patch after inadvertent dural puncture in parturients did not decrease the incidence of PDPH to the magnitude predicted; the length and severity of PDPH symptoms, however, were decreased. Loeser et al 63 have shown that therapeutic epidural blood patch is not as effective when performed within the first 24-48 h after dural puncture.…”

Complications following large-volume epidural blood patches for postdural puncture headache. Lumbar subdural hematoma and arachnoiditis: initial cause or final effect?

“…Degree of CSF loss or dural damage from the initial "wet tap" may influence the success of EBP at any volume. In addition, timing seems to be a very important factor; initial EBPs performed a full 24 hours following dural puncture are more successful [7], even when relatively smaller volumes of blood are used [8].…”

Prevention of post‐dural puncture headache in parturients: a systematic review and meta‐analysis

“…). After the inclusion criteria were applied and hand searches completed, 40 eligible RCTs remained . The details of these RCTs are reported in Appendix S1, and the results of the RCTs are summarised in Tables and .…”

“…The Jadad scores and the descriptive assessment of the quality of each RCT are included in Appendices S2 and S3. Nineteen of the included trials had Jadad scores of 2 or less . This was mainly due to insufficient description of, or inadequate double blinding and randomisation.…”

“…Four trials studied prophylactic EBP in 173 parturients, and the median (range) quality score was 2 (2–5). PDPH was the primary outcome in all the trials.…”