At today’s Western Anaesthesia Symposium, Joey Costello presented the latest data on post-dural puncture headache. This occurs with 1-3% of epidurals. Unfortunately, the majority of interventions that have been proposed are largely ineffective: caffeine, coca-cola, epidural saline, lying supine etc. There are promising data for co-syntropin and epidural morphine. The epidural blood patch remains the standard of care. The success rate of blood patch is 60-70%. It is 90% for a second patch. The larger the hole in the dura – the greater the likelihood that the blood patch will fail. The longer you wait to do the blood patch, the more likely it is to be successful. Best wait 2 or more days. How much blood to inject? It is unclear – certainly no more than 20ml.