Abstract
The purpose of this report is to describe a new complication of epidural blood patch for inadvertent dural puncture. A dural tap in an obstetric patient was managed initially with a prophylactic blood patch via the epidural catheter. Despite this, 48 hr later, she developed post-dural puncture headache, neck, and shoulder pain, and was given a second epidural blood patch. This was followed by an immediate and severe exacerbation of her symptoms, which later resolved after the administration of diclofenac. There were no further sequelae. Although severe complications of epidural blood patch are rare, they are alarming. Exacerbation of the original symptoms of post-dural puncture headache caused by, or following, epidural blood patching has not previously been reported.
Résumé
Cette observation décrit une nouvelle complication du blood patch épidural réalisé après une ponction accidentelle de la dure-mère. Chez une patiente obstétricale, une ponction accidentelle de la dure-mère est initialement traitée par un blood patch prophylactique administré par le cathéter épidural. Quarante-huit heures plus tard, parce qu’elle se plaint encore d’une céphalée post-dure-mérienne, et d’une douleur au cou et aux épaules, on répète le blood patch. Cette manoeuvre est suivie immédiatement par une aggravation aiguë des symptomes qui disparaissent plus tard avec l’administration de diclofénac. Il n’y a pas de séquelles. Malgré leur rareté, les complications du blood patch épidural sont inquiétantes. L’aggravation des symptomes d’une céphalée post-durale causée ou consécutive au blood patch épidural n’a pas été rapportée jusqu’à maintenant.
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Woodward, W.M., Levy, D.M. & Dixon, A.M. Exacerbation of postdural puncture headache after epidural blood patch. Can J Anaesth 41, 628–631 (1994). https://doi.org/10.1007/BF03010004
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DOI: https://doi.org/10.1007/BF03010004