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Epidural Blood Patch: It Really Works!
Patients often present to the emergency department with post-dural puncture headache (PDPH) after diagnostic or therapeutic lumbar puncture (LP). The headache is severe, starts about 1 day after dural puncture, can be alleviated by lying down, and is often accompanied by nausea, vomiting, or both. Epidural blood patch (EBP), in which autologous blood is injected into the dural space, is advocated for severe or refractory cases. These investigators prospectively studied 504 patients who underwent EBP over a 12-year period at a Paris hospital.
PDPH developed after spinal or epidural anesthesia in 87 patients, diagnostic LP in 363, therapeutic LP in 31, and LP for imaging procedures in 23. Neck pain occurred in 87 percent of cases, and nausea or vomiting occurred in 69 percent. Each patient received an injection of autologous blood. If the patient felt pain or pressure in the back, buttocks, or legs, the injection was stopped after an additional 2 mL was injected; if there was no pain, at least 20 mL was injected.
A mean volume of 23 mL was injected a median of 4 days after the dural puncture. Complete relief occurred in 75 percent of patients, partial relief in 18 percent, and no relief in 7 percent. The response was significantly worse when dural puncture was performed with a needle larger than 20-gauge than when a smaller needle was used (treatment failure, 21 percent vs. 4 percent; partial relief, 38 percent vs. 22 percent).
Comment: No doubt about it, EBP works. It provides an immediate and dramatic cure. Some clinicians recommend waiting at least a few days after headache begins; others advocate earlier treatment. Consider a consult with the anesthesia department for EBP when a patient presents with typical findings 24 or more hours after dural puncture.
— RM Walls
Published in Journal Watch Emergency Medicine October 4, 2001
Citation(s):
Safa-Tisseront V et al. Effectiveness of epidural blood patch in the management of post-dural puncture headache. Anesthesiology 2001 Aug 95 334-339.
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