The management of dural puncture in obstetrics and the efficacy of epidural blood patches.

Epidural blood patch is the definitive treatment for post dural puncture headaches (PDH), providing acceptable short term relief. Disappointingly however debate exists as to their long term success. To investigate their efficacy in our practice, a retrospective audit of all epidural blood patches performed over a four year period was performed. Patients were subsequently followed up using a postal questionnaire and persistent symptom relief and patient satisfaction was measured. During the study period 87 patients required an epidural blood patch, 1 required repeat patches. 71.26% of patients had complete symptom resolution on discharge. The response rate to follow up survey was 73.26% with the majority, 5744%, replying that their symptoms returned following their discharge home. Only 25.53% said they would have an epidural or spinal anaesthetic for future deliveries. Epidural blood patches provide excellent short term relief but long term results are disappointing. Patients receiving epidural blood patches need improved long term follow up.