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122 Epidural blood patch in the 3rd trimester of pregnancy. What about labour analgesia?
  1. P Rebelo,
  2. AS Nogueira and
  3. C Pinto
  1. Hospital Pedro Hispano, Matosinhos, Portugal


Background and Aims Postdural puncture headache (PDPH) is a well-known and common complication of spinal anesthesia which depends upon the characteristics of spinal needle.

Methods We report a blood patch in the 3rd trimester of pregnancy.

Results A 27-year-old healthy women with an history of cervical cerclage at 26 weeks, required a new cervical cerclage at 29 weeks. Spinal anesthesias were performed. In the first surgery a 27G pencil point was used without complications. In the second surgery, 3 attempts were required with a 27G quincke, but as the block failed, general anesthesia was necessary.

Two days after surgery, she developed frontal headache, vomiting, photophobia and noise sensibility that aggravated by orthostatic position. She was apyretic, normotensive and with no neurological deficits. The blood tests were normal except for anemia. Conservative treatment for PDPH was tried with no success and she was offered an epidural blood patch (EBP). The procedure, the risks and benefits were explained. Under aseptic condition the EBP was performed with 20 ml of autologous blood with no complications. The procedure was successful and she was discharged home asymptomatic.

One month later she was admitted with full dilatation. Labor analgesia with epidural was effective.The postoperative course was uneventful.

Conclusions In our case, multiple attempts and the use of a quincke needle increased the risk of PDPH. Even though the time between EBP and the subsequent epidural analgesia was only one month, we speculate that the EBP had no effect on the quality of epidural analgesia.

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