Epidural injection of hydroxyethyl starch in the management of post-dural puncture headache: a case series.

Epidural injection of hydroxyethyl starch may be a suitable alternative for treatment of post-dural puncture headache (PDPH) if epidural blood patch is contraindicated. We reported eight consecutive female patients with accidental dural puncture (ADP), among whom prophylactic or therapeutic epidural injection of hydroxyethyl starch was performed. Prophylactic epidural injection of hydroxyethyl starch 20 ml was conducted once a day for two days, without sufentanil supplementation, and mild PDPH took place in three of four patients. Prophylactic epidural injection of hydroxyethyl starch 20 ml combined with sufentanil 5 μg were performed once a day for two days in three patients, and no PDPH happened. Therapeutic epidural injection of hydroxyethyl starch 20 ml combined with sufentanil 5 μg were carried out once a day for 3 days in the patient whom relatively severe PDPH had occurred. Further prospective studies of epidural injection of hydroxyethyl starch in patients with ADP are required to create evidence-based clinical guidelines for safe practice.