Epidural anesthesia and analgesia are not impaired after dural puncture with or without epidural blood patch

Previous reports have noted a decease in the success of subsequent epidural anesthesia and analgesia in patients who have undergone prior dural punctu re with or without an epidural blood patch. Our retrospective study evaluat ed the success of epidural anesthesia and analgesia in all patients at the Mayo Clinic who had received a prior epidural blood patch over a 12-yr peri od. Each epidural blood patch patient was matched to two patients undergoin g epidural anesthesia after previous dural puncture (without epidural blood patch) and to two patients undergoing epidural anesthesia after previous e pidural anesthetic (without dural puncture/blood patch). These patients wer e matched for the duration of time between the initial procedure and subseq uent epidural anesthetic and the indication (surgery, labor analgesia, post operative analgesia) for which the subsequent epidural was performed. Subse quent epidural anesthesia was successful in 28 of 29 (36.6%, exact 95% CI 8 2.2%-99.9%) patients who had undergone prior blood patch, 55 of 58 (94.8%, 85.6% 98.9%) patients with a history of dural puncture, and 55 of 58 (94.8% , 85.6%-98.9%) patients who had had previous epidural anesthesia. There was no significant difference in the success rate of subsequent epidural anest hesia among groups. We conclude that prior dural puncture, with or without epidural blood patch, does not affect the success rate of subsequent epidur al anesthesia. Implications: Patients with postdural puncture headache shou ld not be denied the benefits of an epidural blood patch because of concern s about the impairment of subsequent epidural anesthetics. The success rate of subsequent epidural anesthesia and analgesia in patients who have under gone dural puncture with or without epidural blood patch is similar to that of patients who have undergone two prior epidural anesthetics.