4.2 Regimen for suspected or proven dural puncture

4.2.1 Before withdrawing needle or catheter consider giving small appropriate dose of analgesia spinally.

4.2.2. The epidural catheter is reinserted in an adjacent interspace and continuous epidural analgesia maintained throughout labour to limit excess straining. First epidural top ups are to be administered only by anaesthesia staff.

4.2.3 In the event of post dural puncture headache, regular analgesia and bed rest are recommended.

4.2.4 Should a significant, persistent headache develop in spite of these measures, then the patient should be considered for an epidural autologous blood patch. The blood patch should be performed with an assistant who is able to perform venipuncture under sterile conditions.