Association Between Injected Volume and Epidural Blood Patch Success on Obstetric Post-Dural-Puncture Headache: A...

Area of Science:

• Obstetrics
• Anesthesiology
• Neurosurgery

Background:

• Post-dural-puncture headache (PDPH) is a common complication following neuraxial procedures.
• Epidural blood patch (EBP) is the primary treatment for PDPH, but optimal injected volume is not well-established.
• Current practice often involves injecting until back pressure is felt, with limited data on volumes >20 mL.

Purpose of the Study:

• To determine if the volume of injected blood during an EBP is associated with improved outcomes in obstetric patients.
• To investigate the relationship between EBP blood volume and the success rate of the initial procedure.
• To assess if larger injected volumes correlate with complete headache symptom resolution.

Main Methods:

• Retrospective review of 317 obstetric patients receiving EBP over 10 years (May 2014-February 2024).
• Primary outcome: failure of the first EBP (requiring a second EBP).
• Secondary outcome: complete symptom resolution after the primary EBP. Binomial generalized model used for analysis.

Main Results:

• Repeat EBP was required in 22.8% of patients.
• Injected volume (median 28.0 mL) and time from PDPH diagnosis to EBP were significantly associated with EBP success.
• Injecting ≥30 mL was associated with significantly higher complete headache resolution (OR 1.85, P =.049).

Conclusions:

• Larger injected blood volumes during EBP are associated with a lower likelihood of requiring a second procedure.
• EBP with ≥30 mL of blood is linked to significantly better headache symptom resolution after the first EBP.
• Prospective trials are warranted to further investigate the etiology of this volume-outcome relationship.