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Postdural puncture headache in a parturient with sickle cell disease: use of an epidural colloid patch

[Céphalées post ponction durale chez une parturiente drépanocytaire : injection péridurale de colloïde]

Bruno Chiron, MD^*, Marc Laffon, MD, Martine Ferrandière and Jean-François Pittet, MD

^* From the Department of Anesthesia, University Hospital, Pointe-a-Pitre, West French Indies;
the Department of Anesthesia, University Hospital, Tours, France;
and the Department of Anesthesia and Surgery, University of California San Francisco, San Francisco, California, USA.

Address correspondence to: Docteur Bruno Chiron, Service d’Anesthésie-Réanimation, Hôpital Bretonneau, 2 bis Boulevard Tonnellé, 37044 Tours cedex – France. Phone: 02 47 47 38 10; Fax: 02 47 47 46 60; E-mail: b.chiron{at}voila.fr

Purpose: To report the injection of a colloid in the epidural space as an alternative to an epidural blood patch in a woman with sickle cell disease.

Clinical features: A Cesarean delivery was performed under spinal anesthesia in a 32-yr-old woman with severe sickle cell disease and a past medical history of vaso-occlusive crisis. In the postoperative period, the patient complained of postdural puncture headache resistant to symptomatic treatment. Because there were no data concerning the safety of a blood patch in this condition, a colloid (a modified fluid gelatin heated to 37°C) was injected in the epidural space instead of blood. Headaches decreased immediately after the epidural injection of the colloid and disappeared totally within 12 hr.

Conclusion: Data concerning the safety of epidural blood patches in patients with sickle cell disease are lacking. Injection of colloids in the epidural space could be an alternative.