Impaired epidural analgesia after dural puncture with and without subsequent blood patch.

We carried out a retrospective assessment of epidural analgesia in 46 parturients who had a previous dural puncture. Of 29 women who had both dural puncture and blood patch previously, only 59% had an uncomplicated successful second epidural anesthetic. Of 17 parturients who had dural puncture but no blood patch previously, only 65% had an uncomplicated successful subsequent epidural anesthetic. In comparable groups of parturients without previous dural puncture, 88%-92% had successful epidural analgesia. The data suggest that dural puncture may lead to impaired epidural analgesia subsequently. Epidural blood patch after dural puncture did not lead to any further decrease in the rate of good analgesia with subsequent epidural anesthetics. Parturients who request epidural analgesia and who have had previous dural puncture with or without blood patch should be informed about the 35%-40% chance of poor epidural analgesia.