Objectives: To assess prophylactic and curative managements of dural taps occurring during the setting of epidural analgesia (EA) for labour.
Study design: Nationwide French retrospective survey.
Patients and methods: From April to July 1997, a questionnaire was sent to 799 French obstetrical units located in both teaching and non-teaching public hospitals and private institutions.
Results: Answers were obtained from 267 units (response rate of 33%). Although management of dural taps was similar in 52% of the institutions, only 8% had produced a written protocol. After a dural puncture, EA was still performed in 95% of the units, but usually in another interspace (87%). Large oral fluid intake was the most frequent prophylactic measure (81%). To prevent postdural puncture headache (PDPH), bed rest was largely used (76%) and lasted 24 hours in 46% of the institutions. Prophylactic epidural blood patch (EBP) was performed in 14% of the units. To treat PDPH, a majority of anaesthesiologists performed an EBP (92%) and most of them after a delay of 48 hours (62%). Intravenous and oral caffeine was used in 31 and 24% of the units respectively. Prior to EBP, coagulation status was assessed in about 20% of the units and blood culture in less than 3%. In 65% of the units the injection of EBP was discontinued when the patients felt backache. A large range of volumes were injected, but usually less than 20 mL were administered (81%). In 60% of the units the patients were discharged home after an overnight stay in the hospital. If the first EBP failed, a second one was performed in 61% of the cases.
Conclusion: Management of dural taps occurring after EA for pain relief in labour differs widely from one French obstetrical unit to another.