Low rate of complications: patch may ease postdural puncture headache.(Obstetrics)

FORT MYERS, FLA. -- Conflicting data regarding the efficacy of prophylactic epidural blood patches for the prevention of postdural puncture headaches in obstetric patients continue to emerge, but studies presented during the annual meeting of the Society for Obstetric Anesthesia and Perinatology suggest that the patches offer women at least some benefit.

In a prospective double-blind study of 64 women who suffered inadvertent dural puncture with a 17-gauge epidural needle and were randomized to receive either a prophylactic blood patch or a sham injection, the incidence of postdural puncture headache (PDPH) was identical in both groups (56%). Peak intensity of headaches, as measured by a Verbal Rating Score for Pain (VRSP) and a visual analog score, also did not differ significantly between the groups.

The duration and severity of symptoms, however, were significantly reduced in the prophylactic blood patch group, Dr. Barbara M. Scavone reported.

Those with headache in the prophylactic blood patch group experienced a median 2 headache days, compared with 5 headache days for those in the sham injection group.

The severity of headache, as measured by the area under the "VRSP multiplied by days" curve, was a median of 10 in the blood patch group, compared with 19 in the sham injection group, said Dr. Scavone, of the department of anesthesiology at Northwestern University, Chicago.

While a prophylactic blood patch did not decrease the incidence of PDPH in this study, it did decrease the duration and severity of symptoms.

Furthermore, there ...