anytime the "second EBP doesn't work" start thinking about issues with the venous system adjacent to the dura in the brain; I think it may be a dural venous sinus, it may also be a thromobosis; someone here probably remembers the name; happens after pregnancy; neurologists may never see it or hear about it; looks and acts like PDPH and/or meningitis; you may need an MRI see it vs a CT; do this ASAP
also, on the pain forum, a guy conducted a liitle study of what happens when you mix contrast with blood for an EBP, and long story short, it doesn't coag like if there were no contrast mixed in; most pain guys will shoot contrast when they do an EBP under flouro so they mix in the epidural space; your guy probably did this;
I recommend you get a CT with contrast or MRI, whatever is needed to rule out the venous issues in the brain, and while she is in the scanner, also get an MRI of the lumbar spine to see what may need to be re-injected; you can ask the radiologist to calculate from the MRI what the skin to epidural space distance is at the trajectory you plan to use t the level you plan to go so you know when to expect your LOR (which you may not get) b/c if you repeat the EBP, you want to do it without contrast
alternatively you could come in caudally and thread a catheter up to the right level which can be done without contrast mixing with the blood too much
also, you can get a nuclear med scan (indio scan) to tell you where the leak is; the pt needs an IT injection of the radionuclide and it takes hours or the uptake to run through the body as they do delayed imaging too; they may ask you to do the IT injection; get your MRI first and the blessing of the neurologist for medicolegal CYA reasons
use chlorhexidine instead of betadine as multiple epidural sticks with betadine in a short amount of time has been rumored to contribute to arachnoiditis
add an abdominal binder too if you do or do not re-patch her
cosyntropin is safe, may not be effective
I would encourage the workup but wait a week to re-patch her; if she needs help with the baby tell neuro or OBGyn to admit her until she can do her ADLs
also try fioricet for PDPH as it has caffeine, acetaminophen, and a weak barbiturate (can give nsaid as well) ...but ti might make them want to pee more which they may not like
