Factors associated with failed epidural blood patch after accidental dural puncture in obstetrics: a prospective, multicentre, international cohort study

• DOI: 10.1016/j.bja.2022.06.040
• Publication Date: 2022-09-03T03:49:00Z
• Authors: Anil Gupta; Marc Van de Velde; Anders Magnuson; Christian von Hey...; Emilia Guasch; Seppo Alahuhta; Frédéric J. Mercier; Alexandra M.J.V. ...; Isabelle Casier; Bart Bryon; Filiep Soetens; Pierre-Yves Dewandre; Geraldine Lambert; Jan Christiaen; Roel Schepers; Patrick Van Houwe; Alain Kalmar; Henk Vanoverschelde; Monique Bauters; Eva Roofthooft; Sarah Devroe; Marc Van de Velde; Ana Jadrijevic; Aleksandra Jokic; Damjan Marin; Ivan Sklebar; Slobodan Mihaljević; Martina Kosinova; Petr Stourac; Milan Adamus; Christian Kufa; Ivana Volfová; Blažena Zaoralová; Christina Froesle...; Bjoern Mygil; Charlotte Krebs A...; Tomi Kavasmaa; Seppo Alahuhta; Anne Mäyrä; Susanna Mennander; Kati Rautaneva; Tuula Hiekkanen; Vesa Kontinen; Kirsti Linden; Sara Toivakka; Emmanuel Boselli; Pierre-Édouard Greil; Olivier Mascle; Aurelie Courbon; Jean. Lutz; Thérèse Simonet; Marie Barbier; Tarik Hlioua; Fleur Meniolle d’...; Christine Quintin; Karim Bouattour; Agnès Lecinq; Frederic Mercier; Marie-Pierre Bonnet; Mathieu Carbonniere; Catherine Fischer; Paola-Carla Picard; Martine Bonnin; Brigitte Storme; Anne-Sophie Bouthors; Thomas Detente; Truong Minh Nguyen; Hawa Keita; Sophie Nebout; Lauranne Osse; Anne Delmas; Florence Vial; Lutz Kaufner; Christoph Hoefing; Stefan Mueller; Karin Becke; Manfred Blobner; Heidrun Lewald; Stefan Josef Scha...; Ellis Muggleton; Birgit Bette; Claudia Neumann; Stefan Weber; Matthias Grünewald; Henning Ohnesorge; Antonia Helf; Yvonne Jelting; Peter Kranke; Christian von Hey...; Sabine Welfle; Chryssoula Staikou; Antonia Stavriano...; Mattheios Stamelos; Konstantina Kalopita; Anastasia Loukeri; Dimitrios Valsamidis; Paraskevi Matsota; Adalbjörn Thorste...; Riad Tome; Leonid A. Eidelman; Atara Davis; Sharon Orbach-Zinger; Alexander Ioscovich; Iacob Ramona; Luigi De Simone; Barbara Pesetti; Luca Brazzi; Alessandro Zito; Michela Camorcia; Giorgio Della Rocca; Marco Aversano; Maria Grazia Frigo; Cristina Todde; Andrius Macas; Grazina Keraitiene; Kestutis Rimaitis; Francis Borg; Carl Tua; Agnes Geertje Kui...; Alexandra Schyns-...; Markus W. Hollmann; Tijs van den Berg; Eric Koolen; Ilse Dons; Anouk van der Knijff; Caroline van der ...; Nele Ruysschaert; Michal Pelka; Christine Pluymakers; Seppe Koopman; Aart-Jan Teunissen; Dick Cornelisse; Nick van Dasselaar; Bastiaan Verdouw; Ingrid Beenakkers; Vegard Dahl; Robert Hagen; Francesco Vivaldi; John Reidar Eriksen; Radovan Wiszt; Naz Aslam Tayyba; Else-Marie Ringvold; Radosław Chutkowski; Tomasz Skirecki; Bartłomiej Wódarski; Maria Aida Faria; Amélia Ferreira; Ana Catarina Sampaio; Irene Ferreira; Bernardo Matias; Joana Teixeira; Rita Araujo; Herminia Cabido; Rosario Fortuna; Paulo Lemos; Carolina Cardoso; Fernando Moura; Cristiana Pereira; Sandra Pereira; Manuel Abecasis; Filipa Lança; Paulo Muchacho; Lucindo Ormonde; Isabel Guedes-Araujo; Vitor Pinho-Oliveira; Paulo Paredes; Carla Bentes; Francisco Gouveia; Ana Milheiro; Cláudia Castanheira; Miriam Neves; Vânia Pacheco; Mara Cortez; Raquel Tranquada; Glória Tareco; Inês Furtado; Estela Pereira; Luísa Marinho; Manuel Seabra; Aleksandra Bulasevic; Mirjana Kendrisic; Lidija Jovanovic; Borislava Pujić; Marija Kutlesic; Monika Grochova; Jana Simonova; Gordana Pavlovic; Ales Rozman; Iva Blajic; Dragan Graovac; Tatjana Stopar Pi...; Teresa Chiquito; Pablo Monedero; Joaquin De Carlos...; Roque Guillén-Casbas; Leonor Veiga-Gil; Morena Basso; Carolina Garcia B...; Cristian Hernandez; Laura Ricol; Maroto Pinar De S...; Josep A. Gràcia S...; Manuel López-Baam...; Marta Magaldi Men...; Ana María Plaza M...; Marina Vendrell; Lourdes Trillo; Anibal Ricardo Pe...; Clara Alamillo Salas; Enric Moret; Laura Ramió; Jose Luis Aguilar...; Maria Soler Pedrola; Maria Inmaculada ...; Gorka Aldalur; Estíbaliz Bárcena; Julia Herrera; Fernando Iturri; Alberto Martínez; Leire Martínez; Rosa Serna; Fernando Gilsanz; Emilia Guasch Are...; Fabrizio Iannuccelli; Julieta Latorre; Cristina Rodrigue...; Osvaldo Ceferino ...; Natalia Sierra Bi...; Ceferina Suárez C...; Lourdes Hernández...; Caridad Remacha G...; Raquel Sánchez Nuez; Diego Anta; Jose M. Beleña; Carmen García-Cua...; Irene Garcia; Susana Manrique; Elena Suarez; Anette Hein; Elisabet Arbman; Helena Hansson; Monika Tillenius; Ruaa Al-Taie; Susanne Ledin-Eri...; Anja Lindén-Söndersö; Ola Rosén; Evija Austruma; Lars Gillberg; Bijan Darvish; Anil Gupta; Henrik Jörnvall; Johan Nordström; Jan Persson; Jan Rosenberg; Lars Brühne; Johan Forshammar; Malin Ugarph Edfeldt; Håkan Rolfsson; Anna Hellblom; Katarina Levin; Sofus Rabow; Karin Thorlacius; Peter Bansch; Moira Robertson (...; Ulrike Stamer; Stanislas Mathivon; Georges Savoldelli; Pia Auf der Maur; Miodrag Filipovic; Alexander Dullenkopf; Maya Brunner; Thierry Girard; Claudia Vonlanthen; Sule Ozbilgin; Berrin Gunaydin D; Pelin Corman Dincer; Ayca Tas Tuna; Sylvia Daamen; Slama Farsi; Prisca Feijten; Pierre Harlet; Brigitte Leva; Benoît Plichon
• Keywords: Male; Migraine Disorders; Punctures; 3. Good health; Cohort Studies; Obstetrics; 03 medical and health sciences; 0302 clinical medicine; Pregnancy; Humans; Female; Prospective Studies; Post-Dural Puncture Headache; Blood Patch, Epidural; Retrospective Studies

Epidural blood patch is commonly used for management of post-dural puncture headache after accidental dural puncture. The primary aim was to determine factors associated with failed epidural blood patch.In this prospective, multicentre, international cohort study, parturients ≥18 yr receiving an epidural blood patch for treatment of post-dural puncture headache were included. Failed epidural blood patch was defined as headache intensity numeric rating scale (NRS) score ≥7 in the upright position at 4, 24, or 48 h, or the need for a second epidural blood patch, and complete success by NRS=0 at 0-48 h after epidural blood patch. All others were considered partial success. Multinominal logistic regression was used for statistical analyses with P<0.01 considered statistically significant.In all, 643 women received an epidural blood patch. Complete data to classify failure were available in 591 (91.9%) women. Failed epidural blood patch occurred in 167 (28.3%) patients; 195 (33.0%) were completely successful and 229 (38.7%) partially successful. A total of 126 women (19.8%) received a second epidural blood patch. A statistically significant association with failure was observed in patients with a history of migraine, when the accidental dural puncture occurred between lumbar levels L1/L3 compared with L3/L5 and when epidural blood patch was performed <48 h compared with ≥48 h after accidental dural puncture. In patients having radiological investigations, three intracranial bleeds were diagnosed.Failed epidural blood patch occurred in 28.3% of women. Independent modifiable factors associated with failure were higher lumbar level of accidental dural puncture and short interval between accidental dural puncture and epidural blood patch. A history of migraine was associated with a higher risk of second epidural blood patch.NCT02362828.