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REGIONAL ANESTHESIA AND PAIN MANAGEMENT

Epidural Anesthesia and Analgesia Are Not Impaired After Dural Puncture With or Without Epidural Blood Patch

James R. Hebl, MD^*, Terese T. Horlocker, MD^*, Robert C. Chantigian, MD^*, and Darrell R. Schroeder, MS

Departments of *Anesthesiology and Health Sciences Research, Mayo Clinic, Rochester, Minnesota

Address correspondence and reprint requests to Terese T. Horlocker, MD, Department of Anesthesiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905. Address e-mail to horlocker .terese{at}mayo.edu

Previous reports have noted a decrease in the success of subsequent epidural anesthesia and analgesia in patients who have undergone prior dural puncture with or without an epidural blood patch. Our retrospective study evaluated the success of epidural anesthesia and analgesia in all patients at the Mayo Clinic who had received a prior epidural blood patch over a 12-yr period. Each epidural blood patch patient was matched to two patients undergoing epidural anesthesia after previous dural puncture (without epidural blood patch) and to two patients undergoing epidural anesthesia after previous epidural anesthetic (without dural puncture/blood patch). These patients were matched for the duration of time between the initial procedure and subsequent epidural anesthetic and the indication (surgery, labor analgesia, postoperative analgesia) for which the subsequent epidural was performed. Subsequent epidural anesthesia was successful in 28 of 29 (96.6%, exact 95% CI 82.2%–99.9%) patients who had undergone prior blood patch, 55 of 58 (94.8%, 85.6%–98.9%) patients with a history of dural puncture, and 55 of 58 (94.8%, 85.6%–98.9%) patients who had had previous epidural anesthesia. There was no significant difference in the success rate of subsequent epidural anesthesia among groups. We conclude that prior dural puncture, with or without epidural blood patch, does not affect the success rate of subsequent epidural anesthesia.

Implications: Patients with postdural puncture headache should not be denied the benefits of an epidural blood patch because of concerns about the impairment of subsequent epidural anesthetics. The success rate of subsequent epidural anesthesia and analgesia in patients who have undergone dural puncture with or without epidural blood patch is similar to that of patients who have undergone two prior epidural anesthetics.

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				J. P. R. Loughrey, S. Eappen, and L. C. Tsen Spinal Anesthesia for Cesarean Delivery Shortly After an Epidural Blood Patch Anesth. Analg., February 1, 2003; 96(2): 545 - 547. [Abstract] [Full Text] [PDF]

				B. Ong, J. R. Hebl, M. T. T. Horlocker, and M. R. C. Chantigian Epidural Analgesia After Dural Puncture • Response Anesth. Analg., February 1, 2000; 90(2): 502 - 502. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999