The procedure can be done blind or under fluoroscopic or ct guidance, and is performed predominantly by radiologists and anesthesiologists. An epidural blood patch may also help reduce other spinal fluid leak. Your healthcare provider will inject a sample of your own blood into your back, near the dural puncture site. Just as with an epidural, this is a procedure undertaken as a strict aseptic technique, where blood is taken from the womans arm and injected into the epidural space. The volume of blood for epidural blood patch in obstetrics. In this report, we describe a technique that can be used to perform an ebp in pediatric patients. The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture spinal tap. We report the technique of placing an anterior cervical blood patch for a large cervical ventral leak. This headache is often described as a headache like no other, being more severe when the patient is. In quite a few cases, however, the leaked csf is spread over a large area along the spinal epidural space, making it difficult for the surgeon to clearly. The severity of the headache was evaluated at baseline and 1 hour following injection.
The volume injected displaces cerebrospinal fluid csf from the lumbar csf space into the area surrounding the brain, often yielding immediate. A spinal headache may occur up to 5 days after the lumbar puncture. If the heparin lock cannot be placed, then up to 15 ml. Approximately 1520 mls of blood is taken from a vein in the patients arm and subsequently injected into the epidural space in. She would only accept a blood patch if a closed circuit was established between her circulation and the epidural space. Epidural catheter offers alternative to traditional blood. Blind epidural blood patch for spontaneous intracranial. Epidural blood patch technique, recovery, and success rate. Most patients do not report any pain or discomfort during the procedure. An epidural blood patch ebp can be used to treat a postdural puncture headache pdph when conservative management has failed. Indications severe, persistent spinal headaches for more than 2 days after a spine procedure e. The presence and severity of headache were reassessed at 2, 4, 8, 24, 48, and 72 hours and 5 days postprocedure by telephone if discharged. 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.
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. An epidural blood patch is a procedure used to relieve a headache caused by spinal fluid leak after a dural puncture. Epidural blood patch was performed at the t1 to t2 level, the presumed location of the leak due to presence of a bone spur on ct and the large corresponding csf collection. The epidural placement is performed by a trained practitioner using aseptic technique and the vertebral space accessed is at or immediately below the original neuraxial placement. First introduced over half a century ago as a treatment for intractable postural puncture headache pdph.
In rare instances, severe adverse effects can occur. Epidural blood patch is a widely used technique to treat spinal headache and persistent leak of cerebrospinal fluid csf from the subarachnoid space. Several studies have suggested that a prophylactic epidural blood patch ebp, administered shortly after delivery before the epidural catheter is removed, may decrease the incidence of pdph or the need for therapeutic ebp. Epidural blood patch is an iatrogenic epidural hematoma. We describe a novel use of an epidural blood patch ebp for treatment of persistent postdural puncture positional vertigo. Epidural patching medical clinical policy bulletins aetna. He was able to show presence of blood in the epidural space at the cervical levels on postprocedure mris.
This injection technique is performed after a patient has received a lumbar puncture, usually from an epidural during labor, diagnostic spinal tap. A small amount of the patients own blood is injected into the epidural space, clotting and closing the site of. Autologous epidural blood patch aebp is effective for postduralpuncture headache pdph. Traditionally, ebp is performed by placing a needle in the epidural space through an interlaminar. Methods ninetyfour patients with sih underwent ebps. Treatment of postdural puncture headache in postpartum. The blood clots, helping to patch punctures after a spinal tap procedure.
The patient is positioned in the sitting or lateral positon. 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. Epidural blood patch for postdural puncture positional vertigo. This quickly led to resolution of the headache and cranial nerve palsies, and later to the complete resolution of his sdh. In two previous reports on the use of epidural blood patch in the paediatric population, 5 and 8 ml of blood were given to children aged 9 and 12 yr respectively.
Epidural blood patch is a treatment option for patients with craniospinal hypotension or post lumbar puncture headaches. The mainstay of treatment of postdural puncture headache is the administration of autologous blood into the epidural space. If the headache remained severe, an epidural blood patch was performed. Ten patients with postdural puncture headache presenting for an epidural blood patch were given either saline or sumatriptan subcutaneously. Postdural puncture headache is a leak of cerebrospinal fluid that lowers intracranial pressure and usually presents as a positional headache. The use of fluoroscopy permits the targeting of the site of previous dural puncture or suspected dural leak to perform the epidural blood patch, it is probably best to start a heparin lock in the patient first. In some cases, repeat procedures are required for complete cure. There was, however, some reluctance among the senior anaesthetic staff to perform an ebp for a number of reasons.
Using aseptic technique, 20ml of autologous blood is drawn by a trained practitioner. Refractory cases of both pdph and sih typically resolve with the use of an epidural blood patch ebp. Transforaminal blood patch for the treatment of chronic. The blood is believed to clot in the epidural space and plug the hole in the dural sac, limiting further csf leak. The vertebral space where the ebp was performed is depicted in figure 2. A twolevel largevolume epidural blood patch protocol for.
Effectiveness of epidural blood patch in the management of. 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. An epidural blood patch ebp is a procedure in which a small volume of autologous blood is injected into a. Epidural blood patch may be used to treat postduralpuncture headache, leakage of cerebrospinal fluid due to accidental dural puncture occurring in approximately 1. The technique for the ebp is the same as used for epidural steroid injection except that autologous unclotted blood is injected. Epidural blood patch was conducted by experienced staff anesthesiologists, during strict surgical aseptic conditions, on a. The mean spread of the blood patch in the epidural space has been found to be 4. Epidural blood patch an overview sciencedirect topics. An epidural blood patch ebp is a widely accepted standard procedure to treat csf hypovolemia, especially when the epidural csf leak is detected by spinal mri or ct myelography ctm. As with any procedure, there is a slight risk of infection.
Epidural blood patch inpatient care what you need to know. This technique is known as epidural blood patch and is highly successful in the treatment of postdural puncture 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. The headache was categorized as mild, moderate, or severe. 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. Our initial assessment concluded that the diagnosis of sih was not in question. An epidural blood patch is thought to be effective through the formation of a gelatinous cover over the dural hole by the injected blood. Insertion site at the site of the prior lumbar puncture leak site or below that site. 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. To our best knowledge, this approach has not been reported. A novel technique of multiplesite epidural blood patch. The interlaminar approach is the most commonly used technique for an epidural blood patch. Repeat epidural blood patch at the level of unintentional.
If conservative treatments are not successful, the epidural blood patch is the gold standard of the treatment for dural puncture. Patients blood 2030 cc is collected using sterile technique. An epidural blood patch is a surgical procedure that provides immediate relief to the headache caused by leaking spinal fluid. 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. Epidural blood patch can cause acute neurologic deterioration. The most definitive imaging technique for epidural or spinal hematoma is probably a combination of myelography and thinsection ct scan. A small amount of the patients blood is injected into the epidural space near the site of. Recovery time is short and patients can resume their normal activities. Epidural blood patch spine and pain specialists utah. Epidural blood patch is an effective treatment for patients with severe postdural pucnture headache when performed with an appropriate technique and at an appropriate time. We present a case of neurologically complicated aebps, one of which was performed at the interspace of unintentional dural puncture udp. Pediatric epidural and spinal anesthesia and analgesia.
Technique, timing and administration practice pamela flood, md stanford university sol shnider 2018. Ctguided epidural blood patching of directly observed or. A safe method for performing an epidural blood patch in a. 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.
Epidural blood patch in post dural puncture headache. Background we report a retrospective analysis of a twolevel, variablevolume epidural blood patch ebp technique for the treatment of spontaneous intracranial hypotension sih. Targeted transforaminal epidural blood patch for postdural. Epidural blood patch was performed after a median delay of 4 days range, 153 days after dural puncture. Efficacy of a prophylactic epidural blood patch in. An epidural blood patch is a minimally invasive procedure that uses autologous blood to close holes in the dura mater of the spinal cord. Epidural blood patch definition of epidural blood patch. The classic symptom of cerebrospinal fluid csf loss from disruption of spinal dura is headache associated with upright posture. The blood patch procedure consists of an injection at the spinal tap site of a small quantity of autologous blood. Feasibility of placement of an anterior cervical epidural. Details of the epidural blood patch technique, including the presence of back pain and the actual volume of blood administered, were recorded. An epidural blood patch is a treatment for spinal headaches. 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 reported incidence of postdural puncture headache pdph is up to 40% and typically occurs within the first few days post procedure.
Needle is inserted through ligamentum flavum crunchy and then a pop is felt. In quite a few cases, however, the leaked csf is spread over a large area along the spinal epidural space, making it difficult for the surgeon. Epidural blood patch imaging glossary patients ur medicine. Although current finegauge needles have reduced the incidence of pdph, the adverse event still occurs, and depends on several factors, including needle size and. Effectiveness of epidural blood patch in the management of post. An epidural blood patch ebp is a procedure in which a small volume of autologous blood is injected into a patients. The dorsal epidural blood patch is a commonly used management technique for spontaneous intracranial hypotension from a dural csf leak, but it may be less efficacious for cervical or ventral leaks. The patient was subsequently referred for an anaesthetic opinion with a view to treatment using an epidural blood patch ebp.
The chances of having a spinal headache depend on many factors including age, weight and size of needle used for the procedure. Gormley described this technique in 1960 and it remains the treatment of choice when conservative management has been ineffective 4, 6, 11. Epidural blood patch in the treatment of post dural puncture headache. An epidural blood patch is a procedure to treat a headache caused by leaking cerebrospinal. Low back pain following epidural blood patch sciencedirect. Injectate volume was variable and guided by the onset of back pain, radiculopathy or symptoms referable to the ebp. The success of the first epidural blood patch is in the region.
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