Effectiveness of epidural blood patch in the management of postdural puncture headache. In the short term, the epidural blood patch seals the hole and relieves csf hypotension both by mass effect from csf cranial displacement and by increasing intracranial volume and presure. Epidural blood patch ebp conventionally refers to the injection of autologous blood into the epidural space with the intent to seal off a dural tear and to stop cerebrospinal fluid csf leak. Metaanalysis 4 rcts, n173 low quality jadad 2 no significant difference in incidence of pdph 3. The dural tear often occurs at the thoracic or cervical level. This procedure is commonly done to treat spinal headache, usually resulting from of a loss of csf following a lumbar puncture or myelogram. Epidural blood patch portland pain care and mednet. We report a retrospective analysis of a twolevel, variablevolume epidural blood patch ebp technique for the treatment of spontaneous intracranial hypotension sih. Efficacy of a prophylactic epidural blood patch in preventing post dural puncture headache in parturients after inadvertent dural puncture. The information provided should not be used during any medical emergency or for the.
The women under elective caesarean section with epidural anesthesia were excluded from the study. Headaches may happen after certain procedures that involve the spine, such as a myelogram, a spinal tap, or an epidural for anesthesia. The introduction of blood into the epidural space may produce discomfort. Contraindications to performing a blood patch include septicemia. The headache should be typical of a post dural puncture headache, which is relieved by lying flat. The other day i saw a case for a general anesthetic for blood patch placement and assumed it had to be in. Postdural puncture headache and epidural blood patch in a large. But if csf continues to leak and cause debilitating headaches, the best treatment is an epidural blood patch. Click on the postcard to download a copy suitable for sharing on social media. Review of the alternatives to epidural blood patch for treat. Pdph maximum severity of pdph need for therapeutic ebp. Taking care of yourself after an epidural blood patch. The blood is injected slowly 30 to 60 seconds to create a blood patch. An epidural blood patch is a relatively simple procedure in which blood drawn from an intravenous line in your arm is injected into the epidural space in your spine.
Methods ninetyfour patients with sih underwent ebps. Given the risk for spinal cord compression, rigorous assessment for neurological symptoms is necessary throughout the procedure to monitor for complications and determine the endpoint of the ebp injection. The blood patch procedure consists of an injection at the spinal tap site of a small quantity of autologous blood. Efficacy of the epidural blood patch for the treatment of. This lack of standardisa tion is problematic, especially con sidering that. Yet, our understanding of this serious complication remains surprisingly incomplete. Pediatric epidural and spinal anesthesia and analgesia nysora. Secondly the blood clots over the dural hole forming a seal to prevent further csf leak. Largevolume lumbar epidural blood patches, an approach adapted from the treatment of postlumbar puncture headache, are often used for treatment of spontaneous intracranial hypotension and can be effective immediately.
An epidural blood patch may also help reduce other spinal fluid leak. Largevolume blood patch to multiple sites in the epidural space through a singlecatheter access site for treatment of spontaneous intracranial hypotension. Preparation for a epidural blood patch radiology ltd. Epidural blood patch inpatient care what you need to know. Blood patching should normally be performed only after the first 24 h, as prior to this it is associated with lower success rates. After the injection of your blood, the bodys own healing system should take over and finish repairing the spinal fluid leak. Diagnostic tests, procedures, equipment anesthesia epidural. Ctguided epidural blood patching of directly observed or. Approximately 1520 mls of blood is taken from a vein in the patients arm and subsequently injected into the epidural space in the spine at the site of the spinal fluid leak.
Reconfirm epidural placement with another contrast injection, if after injecting 20 ml of blood, the patient does not report symptoms, or there is no increase in the pressure needed to inject blood at the same rate. Effectiveness of epidural blood patch in the management of. Sep 26, 2010 epidural blood patch in postdural puncture headache by dr ashok jadon, md dnb mnams. This lack of protocolisation resulted in employment of a diversity of treatment modalities caffeine, sal ine patch, patientcontrolled epidu ral anaesthesia, various. Large volume lumbar puncture procedures johns hopkins. An epidural blood patch is a surgical procedure that provides immediate relief to the headache caused by leaking spinal fluid. An epidural blood patch ebp is a procedure in which a small volume of autologous blood is injected into a patients epidural space to stop a. The blood clots, helping to patch punctures after a spinal tap procedure. There are reports on epidural blood patch in jehovahs witness patients using a closed system which allows blood collection and epidural injection without loss of continuity. Safety protocol radiographic confirmation with a contrast injection of epidural placement prior to injecting blood.
Neurologic complications related to epidural blood patch include those occurring at the time of the procedure and symptoms predominately happening after epidural blood patch. Obstetric patients requiring epidural blood patch after unintentional dural puncture during epidural catheter insertion were allocated to receive 15, 20, or 30 ml of blood, stratified for the timing of epidural blood patch and center. Epidural blood patch was performed after a median delay of 4 days range, 153 days after dural puncture. You must have a responsible driver to drive you home.
The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture spinal tap. What is the optimal position for the patient to be in when placing an epidural blood patch supine, lateral, prone. The introduction of this blood acts to patch the hole in the dura the outer membrane of the spinal cord that was created by the needle at the time of myelography. A blood patch is a procedure that uses your own blood to help your headache. Maternity guideline epidural blood patch best practice points. An epidural blood patch is a treatment for spinal headaches. Blopp blood patch for post dural puncture headache is a randomised, single centre, observerblind clinical trial. An epidural blood patch should be considered in a patient with a persisting moderate severe headache following definite or suspected dural puncture. Guidelines for the diagnosis, treatment and prevention of. In this case the epidural blood patch is the treatment of choice. Epidural blood patch an overview sciencedirect topics. Intravenous cosyntropin versus epidural blood patch for. This section summarizes the current state of knowledge regarding this familiar iatrogenic problem as well as the closely related topics of accidental, or unintentional, dural puncture adp or udp, respectively, and the epidural blood patch ebp. Although surveys indicate that formal protocols for management of pdph are.
Epidural blood patch can cause acute neurologic deterioration. This study evaluated the efficacy of iv cosyntropin as an alternative to epidural blood patch ebp for refractory or severe postdural puncture headache pdph. Background we report a retrospective analysis of a twolevel, variablevolume epidural blood patch ebp technique for the treatment of spontaneous intracranial hypotension sih. She carried risk for an epidural abscess and sumatriptan was a reasonable choice.
Discomfort occurred in 391 cases 78% after administration of a blood volume of 19 5 ml. It is important to note that there are no absolute right or wrongs when it comes to what you shouldshould not do following a blood patch, nor how. A twolevel largevolume epidural blood patch protocol for spontaneous intracranial hypotension. Epidural blood patch ebp is currently the gold standard for pdph treatment, with. I have done a limited amount of blood patches in my residency probably 34. First introduced over half a century ago as a treatment for intractable postural puncture headache pdph. Additionally, the need for a second blood patch is classi. An epidural blood patch is an injection of your blood into the epidural space. Not all patients have an epidural reinserted these days 2. If these conservative and pharmacologic strategies do not achieve a satisfactory improvement in a reasonable time, an interventional approach should be considered. This complication can happen after a spinal tap, an epidural for labor and delivery, or another procedure that requires a spinal puncture. Epidural blood patch what is an epidural blood patch why. In most cases, a csf leak will seal itself and the headache will resolve. Scavone discusses updates with epidural blood patches at the annual 2015 sol shnider meeting in san francisco, california.
Timing of epidural blood patch wiley online library. The lumbar epidural space was located using a 17gauge vygon, ecouen, france or 18gauge portex, hythe kent, united kingdom tuohy needle, by the lossofresistance technique with fluid. Epidural blood patch is an iatrogenic epidural hematoma. Aftercare following a csf leak or csf leak repair csf leak. Epidural blood patch technique, recovery, and success rate. Systemic infection and fever, infection on the back. An epidural blood patch is thought to be effective through the formation of a gelatinous cover over the dural hole by the injected blood. Guidelines for placement of epidural blood patch epidural blood patch is used to manage a persistent, incapacitating dural puncture headache. In the procedure, a doctor will take a blood sample from a patient and then inject that blood back into a hole in the epidural space. Two patients in the case series had relative contraindication to an epidural blood patch. Effectiveness of epidural blood patch in the management of post. The most common intervention to resolve a spinal csf leak that hasnt resolved on its own is an epidural blood patch.
An epidural blood patch is a surgical procedure that uses autologous blood in order to close one or many holes in the dura mater of the spinal cord, usually as a result of a previous lumbar puncture. The epidural space is not an injection into the spinal cord itself. High thoraciccervical epidural blood patch for spontaneous. Epidural saline dextran 40 trials showed that compared for ebp, they did not demonstrate any long term ef. The concept of using autologous blood to patch a hole in the meninges was. An epidural blood patch was performed by your anesthesiologist to relieve your headache pain by sealing the hole in the membrane between your spinal cord and epidural space and stoppingthe leaking of spinal fluid. An epidural blood patch is a procedure to treat a headache caused by leaking cerebrospinal suhreebrohspynuhl fluid csf.
Guidelines for the management of post dural puncture headache. The volume of blood for epidural blood patch in obstetrics. A twolevel largevolume epidural blood patch protocol for. This procedure involves injecting about 10 to 20 ml of your own blood into the spinal area to seal the leak. This latter group includes paresthesias, neck ache, facial nerve palsy, and lumbovertebral syndrome. Your healthcare provider will inject a sample of your own blood into your back, near the dural puncture site. Most patients experience immediate relief of all or the majority of their headache pain. An aggressive interventional protocol for early midtrimester prom using a. The goal of the epidural blood patch is to treat the symptoms, typically headache, related to cerebrospinal fluid leaks of any cause.
Although epidural blood patch is the best treatment, there are some patients in whom this treatment is refused or contraindicated. However, a randomized trial that included 18 patients did not find any efficacy of tetracosactide in the treatment of pdph, nor in the reduction of blood patch use 45. Aug 17, 2018 an epidural blood patch is a surgical procedure that provides immediate relief to the headache caused by leaking spinal fluid. A small number of patients usually less then 10% may need to have a second blood patch. Injectate volume was variable and guided by the onset of back pain, radiculopathy or symptoms referable to the ebp. Patients with pdph for at least 24 hours and at most 7 days after lumbar puncture will be randomised to treatment with an epidural blood patch edbp or to conventional treatment, i. Twentyeight patients were randomized to receive ebp or intravenous cosyntropin after diagnosis with postdural puncture headache. Our protocol for a twolevel highvolume blood patch can be used to treat sih but does not result in higher rates of success and carries risk. Feb 03, 2020 an epidural blood patch is a procedure used to relieve a headache caused by spinal fluid leak after a dural puncture. A very small percentage less than 1% in our practice of patients develop headache pain following a spinal anesthetic or epidural for. Epidural blood patch the high success rate 6890% after. Injectate volume was variable and guided by the onset of back pain, radiculopathy or symptoms referable to the. Epidural blood patch was conducted by experienced staff anesthesiologists, during strict surgical aseptic conditions, on a patient in a sitting position with the legs dependent.
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