Pdf effective epidural blood patch volumes for postdural. Hi all, got the nasty headache, had a blood patch done on friday. Effectiveness of epidural blood patch in the management of. Epidural blood patch edbp is the most commonly used method to treat postdural puncture headache pdph. In patients with severe pain or in patient in whom the pdph and associated symptoms overly interfere with daily activity, and epidural blood patch may be performed. 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. A medline search was made for relevant publications using keywordsepidural blood patch, prophylactic epidural blood patch, dural puncture, andpostdural puncture headache. A small number of patients usually less then 10% may need to have a second blood patch.
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. Epidural blood patch definition of epidural blood patch. The volume of blood for epidural blood patch in obstetrics. A blood patch is a procedure that uses your own blood to help your headache. 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. A spinal headache may occur up to 5 days after the lumbar puncture. Doctors give unbiased, helpful information on indications, contraindications, benefits, and complications.
Epidural blood patch an overview sciencedirect topics. The headache is caused by a skin where the needle will go. Epidural blood patch inpatient care what you need to know. We found that 15, 20, and 30 ml of blood were of similar efficacy with respect to permanent or partial relief of postdural puncture headache. An epidural blood patch uses a small amount of blood to create a seal. The vertebral space where the ebp was performed is depicted in figure 2. The technique of epidural blood patch has been described elsewhere. The treatment options range from conservative supportive measures to epidural blood patch. We report the clinical and imaging presentation of a case of intracranial hypotension caused by. Wong, md, and epidural blood patch trial group background. This report aimed at presenting two cases of jehovahs witness patients with postdural puncture headache and treated with epidural blood patch in a closed venous blood transfusion system to the epidural space. At any given time, the total volume of csf in the adult is 150ml, of which. Those who do not respond to epidural blood patch are typically considered to have refractory headaches, although the exact definition of refractory headache has not yet been agreed upon by the medical community lampl et al. Because the symptoms of rebound intracranial hypertension may bear some similarity to those of intracranial.
Secondly the blood clots over the dural hole forming a seal to prevent further csf leak. Intraventricular hemorrhage after epidural blood patching. The first was a 71yearold woman who had new onset of nontraumatic ivh on computed tomography ct scan after undergoing an epidural blood patch ebp. The volume injected displaces cerebrospinal fluid csf from the lumbar csf space into the area surrounding the brain, often yielding immediate. Epidural blood patch technique, recovery, and success rate. An epidural blood patch is a treatment for spinal headaches. Your healthcare provider will inject a sample of your own blood into your back, near the dural puncture site. An epidural blood patch is a procedure used to relieve a headache caused by spinal fluid leak after a dural puncture. 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. Scavone discusses updates with epidural blood patches at the annual 2015 sol shnider meeting in san francisco, california. Synonyms for epidural blood patch in free thesaurus. The technique predated the lumbar approach to epidural block by several years. Discomfort occurred in 391 cases 78% after administration of a blood volume of 19 5 ml. A volume of 12 to 18 ml of autologous blood is injected slowly into the epidural space at the level of dural puncture under strict aseptic precautions.
The chances of having a spinal headache depend on many factors including age, weight and size of needle used for the procedure. We present this case of c23 leakage with successful treatment by ebp with high volume 20 ml blood injection from the t7t8 region. After the injection of your blood, the bodys own healing system should take over and finish repairing the spinal fluid leak. This amount of intraventricular blood was deemed an incidental finding since it was of very small volume. Efficacy of the epidural blood patch for the treatment of. The authors present two cases of intraventricular hemorrhage ivh believed to be a result of epidural blood patching. My injection was in the back of my neck and they put the blood patch through my lower back. An epidural blood patch ebp is now considered the treatment of first choice for spinal csf leakage in those patients who have not responded to initial conservative management. You must have a responsible driver to drive you home. Over the last 50 years, there has been a progressive increase in the volume of blood injected for therapeutic epidural blood patches from gormleys original. Guidelines for the management of post dural puncture. The autologous epidural blood patch ebp was first shown to be effective in the treatment of these lowpressure headaches in the 1970s.
Epidural blood patch is a treatment option for patients with craniospinal hypotension or post lumbar puncture headaches. In an observational study, complications of intrathecal catheter pumps necessitating surgical exchange were analyzed. Regional spinal, epidural, caudal flashcards quizlet. Uncontrolled studies report rapid recovery after patching in 90% to 100% of treated patients. Epidural blood patch what is an epidural blood patch. Rebound intracranial hypertension is a complication of epidural blood patching for treatment of intracranial hypotension characterized by increased intracranial pressure, resulting in potentially severe headache, nausea, and vomiting. If these conservative and pharmacologic strategies do not achieve a satisfactory improvement in a reasonable time, an interventional approach should be considered. Post dural punction headache pdph occurs in 10% to 40% of the patients who had a lumbar puncture. Epidural blood patch has traditionally been performed in the lumbar area, with few cases reported in the thoracic and lower cervical spine 1, 3, 4.
Pdph maximum severity of pdph need for therapeutic ebp. Epidural blood patching with closed system is a safe, and effective procedure that. This case demonstrated that the epidural blood patch is one of the. Its done after a lumbar puncture lp to restore normal pressure in the spinal fluid.
This headache is often described as a headache like no other, being more severe when the patient is. The procedure can be done blind or under fluoroscopic or ct guidance, and is performed predominantly by radiologists and anesthesiologists. The main indications for ebp are postdural puncture headache or headache associated with spontaneous intracranial hypotension. We performed transforaminal epidural blood patch at the l34 and l45. An alternative approach to traditional epidural blood patch administration in patients with postdural puncture headache who have an indwelling catheter has passed its first test. The sacrum is a triangular bone that consists of the five fused sacral vertebrae s1 s5. Autologous epidural blood patch ebp is a useful technique that may be employed for treatment of postural headaches resulting from cerebrospinal fluid csf leak. Spontaneous intracranial hypotension treated with a. Spontaneous intracranial hypotension sih is an important cause of new daily persistent headache. According to the majority of studies, position is not important. Rarely, after a lumbar puncture, a patient will develop a postlumbar puncture headache. A very small percentage less than 1% in our practice of patients develop headache pain following a spinal anesthetic or epidural for labor analgesia. Epidural blood patch can cause acute neurologic deterioration. Ivc compression makes epidural fat compressed by increasing plexus blood volume to epidural veins see board speed of injection.
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, strati. Dose and volume are important for epidural anesthetics, while concentration is not. Additionally, the need for a second blood patch is classi. This procedure is commonly done to treat spinal headache, usually resulting from of a. For a oneshot epidural, assume a 20 cc dose via lumbar injection will provide a midthoracic level block and then adjust volume as you see fit ex. Multiple sterile syringes for collection and administration of autologous blood. Cases were reported by two different hospitals in two different cities. The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture spinal tap.
Epidural blood patch for the management of postdural puncture headache abdulkadir atim 1, atilla ergin 2, omer yanarates, murat kuyumcu 3, ercan kurt 2 1 beytepe military hospital, department of anesthesiology, ankara 2 gulhane military medical academy, department of aneshesiology, ankara 3 denizli military hospital, department of anesthesiology, denizli. Metaanalysis 4 rcts, n173 low quality jadad 2 no significant difference in incidence of pdph 3. In this case the epidural blood patch is the treatment of choice. Our aim in this multinational, multicenter, randomized, blinded trial was to. Epidural blood patch synonyms, epidural blood patch. Epidural blood patch for an eightmonths history of postdural. Epidural blood patch for the management of postdural. 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. The patient should remain in the horizontal position for the next 12 to 24 hours.
Targeted transforaminal epidural blood patch for postdural. Epidural blood patch completely relieves postdural puncture headache in up to 95% of cases resulting from a spinal technique but less than half of those resulting from epidural insertion. Preparation for a epidural blood patch i 5207337226 i 5202908377 fax i like us on facebook do not eat any solid food 6 hours before your exam, but clear liquids are permitted up until 2 hours before your exam. Also the use of a high volume prophylactic epidural blood patch ebp during surgery for preventing postdural puncture headache pdph with a followup for 1 year is described. Epidural catheter offers alternative to traditional blood patch administration. Taking care of yourself after an epidural blood patch. Fibrin glue has also been used as an alternative to blood, particularly in cases where the use of autologous blood. The blood clots, helping to patch punctures after a spinal tap procedure. Thoracic epidural blood patch with high volume blood for. An additional complication of decreased csf volumes is cranial nerve palsy which leads to decreased blood supply to the nerves. 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.
Epidural blood patch complications answers on healthtap. Last year my surgical volume rose by 24% and we are currently 50% ahead of. Are they supposed to inject the blood patch where they put the epidural injection. In this study we evaluated 3 volumes of blood for epidural blood patch in obstetric patients after unintentional dural puncture with an epidural needle. The classic manifestation of sih is an orthostatic headache, but other neurological symptoms may be present. The ineffectiveness of lumbar spine blood patch for cervical spine leakage may be because the injected blood maximum 20 ml is not enough to reach the leak in the cervical spine. Epidural blood patch was performed after a median delay of 4 days range, 153 days after dural puncture.
Anesthesia epidural blood patch an epidural blood patch is used to relieve a certain type of headache. Not all patients have an epidural reinserted these days 2. The optimal or effective blood volume for epidural injection is still controversial and. The epidural blood patch is widely accepted as the treatment of choice for postdural puncture headache. Epidural blood patch is the most effective therapy for postdural puncture or low intracranial pressuretype headache. Dural puncture cannot cause any brain damage unless there is very high csf cerebrospinal fluid pressure inside the skull increased icp intracranial pressure, in which case the skull contents can herniate outside the. If patient is volume depleted, it is desirable to infuse cc iv. Relief will occur within 2 to 3 hours in more than 90% of patients. This headache is caused by the leakage of cerebral spinal fluid through a small hole in the lining that surrounds your spinal cord. The best prevention of a pdph is to avoid puncture of the dura mater. This is a headache that is worse when the person is standing up and better when he or she is lying down.
Sometimes after the above procedures, spinal fluid leaks out. Curative treatment for the csf leak and postdural puncture headache frequently is accomplished with an epidural blood patch. Headaches may happen after certain procedures that involve the spine, such as a myelogram, a spinal tap, or an epidural for anesthesia. An epidural blood patch is a procedure that removes a small amount of. Efficacy of epidural blood patch with fibrin glue additive. Predictors of the response to an epidural blood patch in. Caudal anesthesia was described at the turn of last century by two french physicians, fernand cathelin and jeananthanase sicard. Our aim in this multinational, multicenter, randomized, blinded trial was to determine the optimum of 3 volumes of autologous blood for an epidural blood patch. Epidural catheter offers alternative to traditional blood. Effectiveness of epidural blood patch in the management of post.
1367 32 1176 1244 1153 227 958 1250 320 1526 1107 413 599 1529 1474 974 1272 846 1137 1474 1041 448 923 1107 1024 526 280 1166 1021 742 400 1575 577 650 1289 1213 19 381 421 1342 419 259 303 4 1348 1403 912