Que faire en cas de brèche de la dure-mère en salle de travail ?

Accidental dural puncture occurs in 1 to 1.5% of attempts of epidural procedure for labour analgesia and it results in post-dural puncture headache in 70% of the cases. Epidural blood patch is the gold standard for post-dural puncture headache. However, up to 30% of patients will require a second epidural blood patch due to return of symptoms, and this procedure has its own complications. Prophylactic treatment is consequently a major issue. Several therapeutic options have been proposed: prophylactic epidural blood patch, intrathecal catheter, epidural morphine injection and IV administration of cosyntropin. But due to a low level of evidence or because of lack of efficiency, none of these therapeutic options can be firmly recommended now.