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OBSTETRIC ANESTHESIA

Epidural Blood Patch Placed in the Presence of an Unknown Cervical Epidural Hematoma

Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts

Address correspondence and reprint requests to Lawrence C. Tsen, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women’s Hospital, 75 Francis St., CWN-L1, Boston, MA 02115. Address e-mail to ltsen{at}zeus.bwh.harvard.edu

We discuss a case detailing a favorable outcome of an epidural blood patch performed in the presence of an unknown cervical epidural hematoma. The case highlights the use of a spinal needle for epidural space confirmation, the importance of waiting for final consultation and radiologic testing results before therapeutic intervention when possible, and the use of an epidural blood patch, even in the setting of a known epidural hematoma.

IMPLICATIONS: The suitability and outcome of an epidural blood patch in the combined setting of a postdural puncture headache and a neuraxial hematoma deserves consideration and further investigation.