A case report of ventral dural puncture: a potential cause of failed epidural blood patch

Post-dural puncture headache (PDPH) is one of the most common complications of neuraxial anaesthesia. In the obstetric population, it can be particularly debilitating as it may affect the mother’s ability to breastfeed, interact, and care for her newborn. An epidural blood patch (EBP) is used to treat PDPHs that have failed to resolve with conservative management.1 There is low evidence for the number of EBPs that should be trialed to treat a PDPH, the level or position at which to attempt the EBP, or the volume of blood that should bee injected. Current evidence suggest that the success rates of one EBP may vary between 60-98% and is generally higher post the second EBP.2 It is still unclear as to the causes of a failed EBP. We present a case of PDPH with imaging demonstrating evidence of a ventral CSF leak which required three EBPs for effective symptom management.