Accidental dural puncture during epidural blood patch: a narrative review

Area of Science:

• Anesthesiology
• Neurosurgery
• Patient Safety

Background:

• The risk of accidental dural puncture (ADP) during epidural blood patch (EBP) procedures for post-dural puncture headache is often cited as 1%, yet documented cases are rare.
• Limited literature and guidance exist regarding the incidence, consequences, and management of ADP during EBP, leading to uncertainty among practitioners.

Approach:

• This review synthesizes available evidence to address key questions surrounding ADP during EBP.
• It estimates the incidence, discusses immediate clinical effects, and evaluates potential management strategies.

Key Points:

• The estimated incidence of ADP during EBP is likely between 0.5% and 1%, occurring approximately 20-30 times annually in the UK.
• Immediate re-attempting of the EBP at a different spinal level is a potentially effective management strategy with no clear evidence of significant harm.
• The risks associated with ADP during EBP are not well-characterized due to limited evidence.

Conclusions:

• Further research and pragmatic, evidence-based guidance are crucial for optimizing the management of patients experiencing ADP during EBP.
• Addressing this iatrogenic complication requires a better understanding of its incidence and the development of standardized protocols.