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Two Blood Patches Have Failed. Now What?

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You’re Wrong, I’m Right

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Abstract

I was not thrilled when the newest patient requested an epidural at the end of my shift on the obstetrics floor. To put it nicely, her anatomy promised it would be a technically challenging procedure—there were no palpable landmarks to speak of on her back. After my Tuohy needle hit bone for a fifth time, I called the supervising anesthesiologist covering obstetric anesthesia that day to provide assistance and moral support. He struggled for several minutes before his needle seemed to find a promising spot. And as he advanced the needle a touch more, his persistence was rewarded with a steady stream of cerebrospinal fluid. A “wet tap”—the attending and I stared at each other. He quickly removed the epidural catheter from the tray and threaded it through the needle into the intrathecal space.

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References

  1. Duffy P, Crosby E. The epidural blood patch: resolving the controversies. Can J Anesth. 1999;46:878–86.

    Article  CAS  PubMed  Google Scholar 

  2. Verstraete S, Walters M, Devroe S, Roofthooft E, Van de Velde M. Lower incidence of post-dural puncture headache with spinal catheterization after accidental dural puncture in obstetric patients. Acta Anaesth Scand. 2014;58:1233–9.

    Article  CAS  PubMed  Google Scholar 

  3. Boonmak P, Boonmak S. Epidural blood patching for preventing and treating post-dural puncture headache. Cochrane Database Syst Rev. 2010;20(1):CD001791.

    Google Scholar 

  4. Agerson AN, Scavone BM. Prophylactic epidural blood patch for unintentional dural puncture for the prevention of postdural puncture headache in parturients. Anesth Analg. 2012;115:133–6.

    Article  PubMed  Google Scholar 

  5. Paech M, Banks S, Gurrin L. An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients. Int J Obstet Anesth. 2001;10:162–7.

    Article  CAS  PubMed  Google Scholar 

  6. Collier CB. Blood patches may cause scarring in the epidural space: two case reports. Int J Obstet Anesth. 2011;20(4):347–51.

    Article  CAS  PubMed  Google Scholar 

  7. Desai MJ, Dave AP, Martin MB. Delayed radicular pain following two large volume epidural blood patches for post dural puncture headache: a case report. Pain Physician. 2010;13:257–62.

    PubMed  Google Scholar 

  8. Arevalo-Rodriguez I, Ciapponi A, Munoz L, Roque I. Bonfill Cosp X. Posture and fluids for preventing post-dural puncture headache. Cochrane Database Syst Rev. 2013;12(7):CD009199.

    Google Scholar 

  9. Basurto Ona X, Martinez Garcia L, Sola I, Bonfill X. Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev. 2013;28(2):001792.

    Google Scholar 

  10. Cohen S, Ramos D, Grubb W, Mellender S, Mohiuddin A, Chiricolo A. Sphenopalatine ganglion block: a safer alternative to epidural blood patch for postdural puncture headache. Reg Anesth Pain Med. 2014;39:563.

    Article  PubMed  Google Scholar 

  11. Ho KY, Gan TJ. Management of persistent post-dural puncture headache after repeated epidural blood patch. Acta Anaesth Scand. 2007;51:633–6.

    Article  PubMed  Google Scholar 

  12. Morley AP, Messer CP. Failure of repeated blood patch in a parturient with spinal headache. Int J Obstet Anest. 1993;2(4):204–6.

    Article  CAS  Google Scholar 

  13. Baysinger C, Pope E, Lochart E, Mercaldo N. The management of accidental dural puncture and postdural puncture headache: a North American survey. J Clin Anesth. 2011;23:349–60.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, New York University Langone Medical Center, 550 First Avenue, New York, New York, 10016, USA

    Alexander Sinofsky

  2. 946 Goss Avenue, Apartment 1306, Louisville, Kentucky, 40217, United States

    Alexander Sinofsky

  3. Department of Anesthesiology, New York University School of Medicine, 301 East 17th St. Room C2-222, New York, New York, 10003, USA

    Arthur Atchabahian

  4. 10 W 15th St #414, New York, New York, 10011, USA

    Arthur Atchabahian

Authors
  1. Alexander Sinofsky
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  2. Arthur Atchabahian
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Corresponding author

Correspondence to Alexander Sinofsky .

Editor information

Editors and Affiliations

  1. Clinical Professor of Anesthesiology, Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, New York, USA

    Corey S. Scher

  2. Assistant Professor, Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois, USA

    Anna Clebone

  3. Clinical Professor of Anesthesiology (Emeritus), Former Assistant Director of Anesthesiology, Bellevue Hospital Center Retired from Department of Anesthesiology, Bellevue Hospital Center, New York University School of Medicine, New York, New York, USA

    Sanford M. Miller

  4. Clinical Associate Professor of Anesthesiology and Surgery, Bellevue Hospital Center, Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, Surgical Intensive Care Unit, New York, New York, USA

    J. David Roccaforte

  5. Department of Anesthesiology, Perioperative Care and Pain Medicine, Vice Chair Faculty Promotion Associate Director Anesthesia Service Bellevue Hospital Center, New York, New York, USA

    Levon M. Capan

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Sinofsky, A., Atchabahian, A. (2017). Two Blood Patches Have Failed. Now What?. In: Scher, C., Clebone, A., Miller, S., Roccaforte, J., Capan, L. (eds) You’re Wrong, I’m Right. Springer, Cham. https://doi.org/10.1007/978-3-319-43169-7_47

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  • DOI: https://doi.org/10.1007/978-3-319-43169-7_47

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43167-3

  • Online ISBN: 978-3-319-43169-7

  • eBook Packages: MedicineMedicine (R0)

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