Epidural Gelatin (Gelfoam®) Patch Treatment for Post Dural Puncture Headache

Epidural gelatin patch in autologous plasma was used to treat post dural puncture headache after two cases of inadvertent dural puncture. Ten millilitres of gel was used, the patients obtaining complete relief of their headache forty minutes after the patch. No untoward effect such as neck stiffness, backache or rise in body temperature was observed. The gelatin patch was found to be a safe and effective method in treating severe post dural puncture headache. However, much more needs to be known about the use of Gelfoam® in this situation, especially in regard to its effectiveness and recurrence rates of post dural puncture headache in a larger series. The incidence of inadvertent dural puncture during epidural block has been reported by various authors as 2.9,1 1.72 and 0.63 per cent and subsequent post dural puncture headache (PDPH) as 76.5 per cent.4 The accepted cause ofPDPH is continuous leakage of cerebrospinal fluid (CSF).5 PDPH following inadvertent dural puncture during epidural block can be prolonged, refractory and incapacitating, causing a financial, physical and psychological burden to the patient and a source of worry to the anaesthesiologist and obstetrician. Several prophylactic and therapeutic regimens have been recommended following accidental puncture, and it is apparent that a wide range of practice exists from a conservative expectant approach to more vigorous management. Initially, attempts to plug the dural rent with pieces of catgut