Ultrasonography-assisted blood patch in an obese puerperal woman with post-dural puncture headache after difficult spinal anesthesia

Abstract

Intradural anaesthesia is considered the technique of choice for caesarean sections, unless contraindicated, as it offers advantages over general anaesthesia. However, much of its success lies in the correct positioning, identification and palpation of landmarks such as the spinous processes and interspinous spaces. Therefore, in patients with poorly identified landmarks, such as obese pregnant women, this is a risk factor for multiple punctures and needle redirection, increasing the possibility of complications such as paraesthesia and post dural puncture headache (PDPH), among others. The following is the case of a pregnant woman with a muscle mass index (BMI) of 60 kg/m2 who underwent caesarean section under intradural anaesthesia and developed PDPH. As the landmarks were not visible on palpation, it was decided to perform an ultrasonography-assisted blood patch.