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KMID : 0352120200350010025
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Journal of Kyung Hee University
2020 Volume.35 No. 1 p.25 ~ p.30
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Treatment of Post-Dural Puncture Headache in Obstetric Patient using Epidural Blood Patch: A Case Report
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Hwang Tae-Jun
Kang Hee-Yong
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Abstract
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Accidental dural puncture (ADP) is a common complication of epidural catheter insertion, and may lead to post-dural puncture headache (PDPH), especially in obstetric patients. PDPH often occurs after ADP and may be associated with significant morbidity (severe headache, subdural hematoma). Conservative treatments such as bed rest, hydration, caffeine and acetaminophen are not effective enough. Epidural blood patch (EBP) is widely used to treat resistant PDPH, even if its efficacy in obstetric patients may be less than among general surgical patients. We report an ADP case before induction of labor in a 37-year-old parturient. Decided to perform epidural analgesia, the first attempt was made at L4-5 level and cerebrospinal fluid (CSF) leakage was observed at 3.5 cm depth. The second attempt was made at the L3-4 level and the catheter was successfully mounted. After 8 hours of ADP, the patient complained of headache and there was no effect of conservative management. The patient was admitted to the outpatient department of the pain clinic in 3 days after ADP and improved after receiving EBP. Through this case report, we will check the risk factor and management of PDPH and summarize the overall EPH.
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KEYWORD
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Accidental dural puncture, Post dural pucture headache, Epidural blood patch
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