What is an Epidural Blood Patch?
An epidural blood patch (EBP) is a procedure that definitively treats a post-dural puncture headache. In this procedure, the patient’s blood is sterilely removed from a blood vessel and injected into the epidural space. Ethnic and racial disparities exist in the use of this effective treatment for managing anesthesia complications during maternal care for labor and delivery.
What is a Post-Dural Puncture Headache?
Post-dural puncture headache (PDPH) is a significant complication of neuraxial anesthesia (e.g., an epidural for labor analgesia). This complication usually occurs when the needle used to perform the procedure accidentally goes deeper than intended (past the epidural space) and pokes a hole in the dura.
A woman who develops PDPH will experience a severe headache worse in the upright position and relieved by lying flat (i.e., postural). She may also have nausea, neck stiffness, back pain, vision changes, dizziness, ear ringing, or decreased hearing.
The American Society of Anesthesiologists recommends an EBP for treating moderate to severe PDPH that is unresponsive to more low-risk treatment methods (like caffeine, oral pain medicine, IV fluids, and bed rest).
Racial Disparities in EBP Use for PDPH
A recent study by Lee et al. analyzed hospitalizations of obstetric patients in the state of New York between 1998-2016. Among 8,921 hospitalizations with post-dural puncture headaches, they found racial disparities in epidural blood patch procedure use. Minority patients received an EBP procedure less often than White patients. This study highlights a racial and ethnic disparity in maternal care in the US.
The reasons for this disparity are probably related to broader racial and ethnic disparities in healthcare for mothers in the United States around delivery time. Minority patients (compared to White patients) have worse maternal outcomes, inadequate pain management, lower labor epidural use rates, and limited access to healthcare. Factors contributing to inequity can be broken down into the following levels: patient, clinician, health care system, and culture. Understanding modifiable factors and addressing them is essential for ensuring equitable healthcare delivery.
Our Study on Racial Disparities in Maternal Care in the US
We validated and updated the previous study by Lee et al. in a more recent and larger, nationally representative dataset using the 2016-2020 National Inpatient Sample. The results of our study, which appear in the December 2024 issue of the journal Anesthesia & Analgesia, highlight the persistence of these disparities on a national level.
Reference
Potnuru, Paul P. MD; Jonna, Srikar MD; Orlando, Barbara MD, PhD, FASA; Nwokolo, Omonele O. MD, FASA. Racial and Ethnic Disparities in Epidural Blood Patch Utilization Among Obstetric Patients in the United States: A Nationwide Analysis, 2016–2020. Anesthesia & Analgesia 139(6):p 1190-1198, December 2024. | DOI: 10.1213/ANE.0000000000006754