A Cochrane review [Abstract] 1 [withdrawn from publication] included 9 RCTs with a total of 379 subjects. They underwent dural puncture for any reason. Four trials with 158 patients evaluated therapeutic and 5 trials with 221 patients prophylactic blood patch.
• Therapeutic blood patch: There was less post-dural puncture headache (PDPH) than with conservative treatment (OR 0.18, 95% CI 0.04 to 0.76, one trial, n=40) or with a sham procedure (OR 0.04, 95% CI 0.00 to 0.39, one trial, n=12). Backache was more common with epidural blood patch (OR 23.17, 95% CI 2.57 to 208.60, one trial, n= 12).
• Prophylactic blood patch: PDPH was improved compared to no treatment (OR 0.11, 95% CI 0.02 to 0.64, one trial, n=21), conservative treatment (OR 0.06, 95% CI 0.03 to 0.14, 2 trials, n=88) and epidural saline patch (OR 0.16, 95% CI 0.04 to 0.55, one trial, n=48). However, prophylactic epidural blood patch did not result in less PDPH than a sham procedure (one trial, n=64).
Comment: The quality of evidence is downgraded by study quality (inadequate allocation concealment) and imprecise results (few patients and wide confidence intervals).
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