PA Medical News about Post-Dural Puncture Headache

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Meningeal (Postdural) Puncture Headache, Unintentional Dural Puncture, and the Epidural Blood Patch: A National Survey of United States Practice
Regional Anesthesia and Pain Medicine, 09/14/09

Harrington B et al. – The preferred method of immediately dealing with an unintentional dural puncture (UDP) when providing analgesia for labor is to reattempt the epidural at another level (73.4%). When intrathecal catheters are used for labor analgesia, they are most often removed immediately after delivery (56.5%). After UDP in the obstetric setting, aggressive hydration and encouraging bed rest are the most frequently used prophylactic measures against the development of MPH. Frequently used treatment options for MPH include aggressive hydration, the EBP, oral caffeine, oral nonopioid analgesics, and bed rest. With the exception of a uniform blood volume (16–20 mL), procedural details of the EBP vary considerably among practitioners. The use of materials other than blood for epidural patch is uncommon. Various measures, many poorly supported by the literature, are used prophylactically after UDP and in the treatment of MPH. Despite being nearly universally used as treatment of MPH, the EBP procedure itself remains largely nonstandardized.