Effectiveness of epidural blood patch in the management of post dural puncture headache. The patient undergone l4s1 spine surgery and had post dural puncture headache. Subdural haematoma after dural puncture headache treated by. To determine the efficacy of epidural blood patch edbp for the treatment of post dural puncture headache pdph.
Jan 12, 2012 in highrisk patients blood patching for preventing and treating post dural puncture headache. The mainstay of treatment of postdural puncture headache is the administration of autologous blood into the epidural space. Effects of the serotonin receptor agonist sumatriptan on postdural puncture headache. Effectiveness of epidural blood patch in the management of post. Theophylline for post dural puncture headache abstract. Epidural blood patch cures post dural puncture headache in 90% of cases d.
But in our intractable cases, lumbar epidural blood patch was not improving headache. Describe how you would perform an epidural blood patch. Spinal headaches are caused by epidurals, lumbar punctures, and nerve blocks. Postdural puncture headache pdph is a relatively common complication associated with neuraxial anesthesia and unintentional dural puncture. The headache is severe and described as searing and spreading like hot metal, involving the back and front of the head and spreading to the neck and shoulders, sometimes involving neck stiffness. The incidence of pdph following spinal anaesthesia is dural puncture 2. Longterm effects of ebp on the incidence of backache, headache and early audiometric deterioration are few or nonexistant.
The authors gave this combo to a patient with postop ileus and pdph, who was scheduled for a blood patch, and noted marked improvement in headache and no need for the blood patch. Post dural puncture headache pdph is a relatively common complication associated with neuraxial anesthesia and unintentional dural puncture. Post dural puncture headache pdph is a complication of puncture of the dura mater one of the membranes around the brain and spinal cord. Postdural puncture bacterial meningitis anesthesiology. The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture spinal tap. Epidural blood patch the high success rate 6890% after. A post dural puncture headache can be treated with an epidural blood patch. The incidence of pdph following spinal anaesthesia is blood patch in post dural puncture headache. Postdural puncture meningitis, despite its rarity, should be on the list of differential diagnosis for any patient who develops headache, neck pain, or both after dural puncture.
Epidural blood patch in post dural puncture headache. Blood patchminor postdural puncture headache are treated with blood patch treatment. Results indicate that this treatment approach is a viable option for people who experience post dural puncture headaches. Research has also repeatedly indicated that an epidural blood patch is a. Your healthcare provider will inject a sample of your own blood into your back, near the dural puncture site.
A small amount of the patients blood is injected into the epidural space. Safatisseront v, thormann f, malassine p, henry m, riou b, coriat p, seebacher j. Epidural blood patch ebp is the gold standard treatment when conservative therapy fails, but has significant risks associated. The reported incidence of postdural puncture headache pdph is up to 40% and typically occurs within the first few days post procedure. A recentlypublished study showed that blood patches can help. Postulated reasons for headache following dural tap include. The authors gave this combo to a patient with post op ileus and pdph, who was scheduled for a blood patch, and noted marked improvement in headache and no need for the blood patch. Epidural blood patch ebp is indicated for the treatment of postdural puncture headache in people who dont respond to conservative.
High or total spinal block is discussed separately. It is postulated that blood injected in the epidural space increases the subarachnoid pressure by causing compression of the thecal sac and forces csf cephalad thereby immediately relieving the headache. In most cases, onetwo patches are needed for successful management. Apr 04, 2018 postdural puncture headache pdpha, as defined by the international headache society, is any headache that develops within 5 days of dural puncture and is not better explained by another cause. 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. Various treatment modalities have been tried for postdural puncture headache pdph among which epidural blood patch ebp remains as the gold standard. Epidural bloodpatch ebp is the gold standard treatment when conservative therapy fails, but has significant risks associated. Cosyntropin versus epidural blood patch ebp for treatment. A volume of 12 to 18 ml of autologous blood is injected slowly into the epidural space at the. In our experience, an epidural blood patch is an effective treatment for postdural puncture tinnitus. Epidural blood patching for preventing and treating post dural puncture headache.
An epidural blood patch may also help reduce other spinal fluid leak. Feb 21, 2018 audiogram revealed a lowfrequency mild sensorineural hearing loss in the left ear prior to the procedure. Its effects are instantaneous and complete resolution is achieved by 24 h. Epidural blood patch cures postdural puncture headache in 90% of cases d. May 01, 2001 the most effective treatment of severe or persistent post. While the classic symptoms of pdpha highlight a positional component that worsens with sitting or standing and improves with lying flat, a small. By her 1month followup, her hearing loss was back to normal. Similar findings are more frequently due postdural puncture headache, but the seriousness of the former diagnosis requires a high index of suspicion. They can lead to a significant decrease in the duration and intensity of headaches.
Epidural blood patch was performed after a median delay of 4 days range, 153 days after dural puncture. We randomised 42 patients who presented with pdph, lasting 24 h to 1 week, to receive edbp n 19 or conservative treatment n 23. Effectiveness of epidural blood patch in the management of. However ebp has its own limitations and complicationsthe procedure is involved and requires collection of blood from the patient and injection of the blood into the epidural space. Postdural puncture headache pdpha, as defined by the international headache society, is any headache that develops within 5 days of dural puncture and is not better explained by another cause. She received l3l4 blood patch but symptom had no improvement. The procedure can be used to relieve post dural puncture headaches caused. Epidural blood patch ebp is a common method for treating postural headache in patients with accidental dural puncture. Mar 20, 2015 cosyntropin versus epidural blood patch ebp for treatment of treatment of post dural puncture headache pdph the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Feb 03, 2020 an epidural blood patch is a procedure used to relieve a headache caused by spinal fluid leak after a dural puncture.
Epidural blood patch an overview sciencedirect topics. Postdural puncture headache pdph is frequently associated with neck, vestibular, cochlear, and ocular symptoms. Epidural blood patch precare what you need to know. Epidural blood patch chicago, post dural puncture headache. Audiogram revealed a lowfrequency mild sensorineural hearing loss in the left ear prior to the procedure. Approximately 1520 ml of blood is drawn from the patient and injected into the epidural space in close proximity to the offending post procedure puncture. After the injection the patients headache may immediately cease. Lumbar puncture and brain herniation in acute bacterial meningitis. A small amount of the patients blood is injected into the epidural space near the site of.
Blood patch for the treatment of postdural puncture tinnitus. Same time assistant draws blood up to 15 ccs from same individual. Review of the alternatives to epidural blood patch for treat. The concept of using autologous blood to patch a hole in the meninges was introduced in late 1960 by dr. Prophylactic epidural blood patch after unintentional dural. The onset of headache after lumbar puncture is usually within 2448 h after dural puncture, 1,5 but contrary to the above definition, it could be delayed by up to 12 days, 6 indicating that the time points in the definition are random. Epidural blood patch ebp is currently the standard treatment for severe post dural puncture headache pdph or for mild cases refractory to conservative measures 1. The vertebral space where the ebp was performed is depicted in figure 2. This technique is known as epidural blood patch and is highly successful in the treatment of postdural puncture headache. Epidural blood patch in the treatment of post dural puncture headache.
May 29, 2014 epidural blood patch ebp is a common method for treating postural headache in patients with accidental dural puncture. Although the headache may rarely present immediately after dural puncture, 7 its occurrence should alert. Discomfort occurred in 391 cases 78% after administration of a blood volume of 19 5 ml. Pathophysiology and management of postdural puncture headache. Efficacy of the epidural blood patch for the treatment of post lumbar. Due to the fact that lesion site was highly suspected in l5s1, we decided to perform caudal epidural blood patch. The epidural needle is placed in epidural space at the level where the spinal leakage is suspected. Ebp was originally thought to be 90% effective with repeat treatment efficacy approaching 96%. To put the blood patch in place, the anesthesiologist will put a needle.
Fluoroscopyguided caudal epidural blood patch for relieving. Atropine is coadministered to reduce some of the side effects, like bradycardia, nausea, or increased secretions. Epidural blood patching for preventing and treating postdural puncture headache. Postdural puncture headache pdph which occurs following a therapeutic or diagnostic dural puncture is marked by 3 classic symptoms, postural. Oct 04, 2018 atropine is coadministered to reduce some of the side effects, like bradycardia, nausea, or increased secretions. The autologous epidural blood patch ebp was first shown to be effective in the treatment of these lowpressure headaches in the 1970s. Intravenous cosyntropin versus epidural blood patch for. Many institutions have no guidelines or protocols for prophylaxis or treatment, which makes the management of pdph quite heterogeneous. The anaesthetist takes blood from your arm and injects it into your back, near to the hole in the dura. Prophylactic epidural blood patch after unintentional dural puncture for the prevention of postdural puncture headache in parturients. In our experience, an epidural blood patch is an effective treatment for post dural puncture tinnitus. Sphenopalatine ganglion block for postdural puncture headache. The primary end point was any headache at 24 h after the start of treatment. Jul 08, 2017 blood patch minor postdural puncture headache are treated with blood patch treatment.
Longterm effects of accidental dural puncture in patients. This feels similar to having the original epidural or spinal injection. Results indicate that this treatment approach is a viable option for people who experience postdural puncture headaches. Efficacy of a prophylactic epidural blood patch in preventing post dural puncture headache in parturients after inadvertent dural puncture. Epidural blood patch inpatient care what you need to know. The epidural blood patch is a very simple, minimally invasive procedure.