Optimal diagnosis and management of spontaneous intracranial hypotension remains uncertain. He was able to show presence of blood in the epidural space at the cervical levels on postprocedure mris. This headache is often described as a headache like no other, being more severe when the patient is. Taking care of yourself after an epidural blood patch. Epidural blood patch is performed by an anesthesiologist. The procedure can be done blind or under fluoroscopic or ct guidance, and is performed predominantly by radiologists and anes. The blood patch procedure consists of an injection at the spinal tap site of a small quantity of autologous blood. Case report of a novel arterialto epidural closedcircuit technique with former anesthesiology fellow ashley screws, md, and assistant professor stephen vose, md. The mean spread of the blood patch in the epidural space has been found to be 4.
Efficacy of a prophylactic epidural blood patch in. Epidural blood patch complications answers on healthtap. Ebp usually requires two anesthesia providers, one to do the epidural, the other to draw blood sterilely. A novel technique of multiplesite epidural blood patch administration for the treatment of cerebrospinal fluid hypovolemia. Technique, timing and administration practice pamela flood. The blood clots, helping to patch punctures after a spinal tap procedure. Blopp blood patch for post dural puncture headache is a randomised, single centre, observerblind clinical trial.
Data on epidural morphine are favorable and because of its long duration of action may obviate the need for ebp. If the blood patch is injected into epidural space through previously placed epidural catheter, it may be. Prior to a womans receiving an epidural block during labor, an important nursing measure is to administer at least 500 ml of lactated ringers solution. Sometimes a large leak requires an epidural blood patch to be performed. Contraindications to performing a blood patch include septicemia. The treatment options range from conservative supportive measures to epidural blood patch.
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 is a recognised treatment for severe and persistent headache following a dural tap. A volume of 12 to 18 ml of autologous blood is injected slowly into the epidural space at the. An epidural blood patch is a procedure used to relieve a headache caused by spinal fluid leak after a dural puncture. About 1525 ml of the patients own blood is drawn and then immediately injected into the epidural space. Although epidural blood patch ebp is considered the goldstandard treatment for drugresistant orthostatic headache in spontaneous intracranial hypotension sih, no clear evidence exists regarding the best administration method of this technique blind vs target procedures. We report the clinical and imaging presentation of a case of intracranial hypotension caused by. Technique, timing and administration practice pamela flood, md duration. To our knowledge, this is the first case report of using an arterialto epidural closedcircuit technique to provide an epidural blood patch to a jehovahs witness. Guidelines for the management of post dural puncture. 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. To put the blood patch in place, the anesthesiologist will. If you get a spinal headache after a procedure, the anesthesiologist can create a patch with your blood to seal the leak. Ebp is also effective in relieving symptoms instantaneously in about one third of the patients and thus it.
An epidural blood patch is thought to be effective through the formation of a gelatinous cover over the dural hole by the injected blood. The resite or placement of an epidural catheter at a different interspace is the most common clinical practice after an adp. 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 catheter offers alternative to traditional blood.
Thirdyear resident, kevin olsen, md, authored the case report titled blood patch in a jehovahs witness. The mainstay of treatment of postdural puncture headache is the administration of autologous blood into the epidural space. Review of the alternatives to epidural blood patch for treat. Epidural steroid injections for pain brigham and womens. Efficacy of the epidural blood patch for the treatment of. This technique can be considered as a treatment option in selected patients with ventral csf leaks for whom traditional techniques are unsuccessful. The volume injected displaces cerebrospinal fluid csf from the lumbar csf space into the area surrounding the brain, often yielding immediate. 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.
Is the epidural blood patch performed through an epidural. A dural puncture is treated with an epidural blood patch that injects the patients blood into the epidural space to repair the puncture. Jul 18, 2011 refractory cases of both pdph and sih typically resolve with the use of an epidural blood patch ebp. Effectiveness of epidural blood patch in the management of. 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. Doctors give unbiased, helpful information on indications, contraindications, benefits, and complications. This headache is caused by the leakage of cerebral spinal fluid through a small hole in the lining that surrounds your spinal cord. Cancer seeding risk from an epidural blood patch in patients. Decide whether to use a single shot, continuous catheter, or intermittent bolus technique. This procedure is done to treat severe spinal headaches caused when an epidural, spinal needle or lumbar puncture accidentally punctures a hole in the outer membrane of the spinal cord causing a leak of spinal fluid. Epidural blood patch ebp is the definitive treatment for low cerebrospinal fluid pressure csf resulting from dural puncture after failure of conservative management. Epidural blood patch definition of epidural blood patch by. Epidural blood patch is a treatment option for patients with craniospinal hypotension or post lumbar puncture headaches. Epidural blood patch can cause acute neurologic deterioration.
The exclusion criteria were a previous epidural blood patch related to the same dural puncture including a prophylactic epidural blood patch, an epidural blood patch scheduled 5 days after the dural puncture, a history of low or radicular back pain requiring treatment during the pregnancy, and another dural puncture at the time. The reported incidence of postdural puncture headache pdph is up to 40% and typically occurs within the first few days post procedure. A very small percentage less than 1% in our practice of patients develop headache pain following a spinal anesthetic or epidural for labor analgesia. Yet, our understanding of this serious complication remains surprisingly incomplete. Expanding epidural patching techniques for spinal csf leak. Epidural blood patch placed in the presence of an unknown. Pediatric epidural and spinal anesthesia and analgesia nysora. This is my second birth and the first epidural i was given an im shot of fentanyl and was completely still during the procedure. Kenneth nelson discusses post dural puncture headache and epidural blood patch at the 2012 sol shnider meeting in san francisco. Which technique can the support person use when the laboring woman is losing control. Refractory cases of both pdph and sih typically resolve with the use of an epidural blood patch ebp. To perform the epidural blood patch, it is probably best to start a heparin lock in the patient first. First, the total number of patients with leukemia or lymphoma who received an epidural blood patch was low even over a year period.
It is recommended that two clinicians be present, one to perform the epidural puncture and the other to with draw blood from the patient. You can manage this and all other alerts in my account. An epidural blood patch ebp is a procedure in which a small volume of autologous blood is injected into a patients. An epidural blood patch may also help reduce other spinal fluid leak. Second, we were unable to evaluate for use of conservative strategies prior to epidural blood patch. Traditionally, ebp is performed by placing a needle in the epidural space through an interlaminar. Second, we were unable to evaluate for use of conservative strategies prior to epidural blood patch placement. Epidural technique the 4 ps for the administration of epidural anesthesia are preparation, position, projection, and puncture. Under fluoroscopic guidance a spinal needle was advanced to the epidural space at l23, and position confirmed with the injection of 5 ml omnipaque 240. Epidural blood patch what is an epidural blood patch why. Ctguided blood patching has been described but has not been evaluated in larger case series. 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.
The technique for the ebp is the same as used for epidural steroid injection except that autologous unclotted blood is injected. It has a high success rate with a low incidence of complications. This technique may prove to be useful in medically refractory cases, including those patients who continue to have symptoms despite the prior administration of conventional epidural blood patches. A small amount of the patients own blood is injected into the epidural space, clotting and closing the site of puncture. After the injection of your blood, the bodys own healing system should take over and finish repairing the spinal fluid leak. This technique is known as epidural blood patch and is highly successful in the treatment of postdural puncture headache. The volume of blood for epidural blood patch in obstetrics. The blood will clot and seal off the hole in the dura causing the spinal fluid leak and the headaches should subside soon after. By insertingan epidural catheter, however, the blood patch can be performed by a single operator. Efficacy of epidural blood patch with fibrin glue additive. 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. During the blood patch i was given fentanyl again and it was successful. Objectivealthough epidural blood patch ebp is considered the goldstandard treatment for drugresistant orthostatic headache in spontaneous intracranial hypotension sih, no clear evidence exists regarding the best administration method of this technique blind vs target procedures. Epidural blood patch an overview sciencedirect topics.
An epidural blood patch is a procedure to treat a headache caused by leaking cerebrospinal suhreebrohspynuhl fluid csf. The chances of having a spinal headache depend on many factors including age, weight and size of needle used for the procedure. Your browser does not currently recognize any of the video formats available. Epidural blood patches ebp are rarely performed at the cervical levels, primarily due to fear of neurological complications such as spinal cord compression. Transforaminal blood patch for the treatment of chronic. Other risks are rare and include bleeding, infection, nerve injury and allergic reaction to the medication. Effectiveness of epidural blood patch in the management of postdural puncture headache you will receive an email whenever this article is corrected, updated, or cited in the literature. Epidural blood patch ebp is an effective treatment of pdph and the success rate is high in many studies 3. Your browser does not currently recognize any of the video formats. Previous case reports have utilized iv access rather than intraarterial access to facilitate closedcircuit epidural blood patch placement.
Jun 25, 2004 epidural blood patch ebp is a commonly performed procedure for the treatment of persistent severe post duralpuncture headache pdph. Gormley described this technique in 1960 and it remains the treatment of choice when conservative management has been ineffective 4, 6, 11. 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. If this occurs, there is a risk of developing a spinal headache, which may be severe and may last for days. Epidural blood patch inpatient care what you need to know. This procedure was nowhere near as painful as my actual lumbar puncture. There is a procedure epidural blood patch that can treat the headache if it occurs and does not improve sufficiently in 48 hours. Aug 17, 2018 an epidural blood patch is a surgical procedure that provides immediate relief to the headache caused by leaking spinal fluid. Basically, a bit of blood is drawn from the patients arm and is injected into the epidural area. The technique of epidural blood patch has been described elsewhere. 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. Direct needle placement in the ventral epidural space via a transforaminal approach for treatment of ventral csf leaks has an excellent technical success rate and safety profile. 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 has traditionally been performed in the lumbar area, with few cases reported in the thoracic and lower cervical spine 1, 3, 4.
A special needle is placed into the epidural space in the lower back using a sterile technique and equipment. Technique, timing and administration practice pamela flood, md. Scavone discusses updates with epidural blood patches at the annual 2015 sol shnider meeting in san francisco, california. The authors do note several limitations to this study. Click here to visit our frequently asked questions about html5. Epidural blood patch precare what you need to know. High thoraciccervical epidural blood patch for spontaneous. However, a subset of patients did appear to receive substantial benefit from the combined fibrin glue blood patching procedure. 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. Cancer seeding risk from an epidural blood patch in. 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 procedure can be done blind or under fluoroscopic or ct guidance, and is performed predominantly by radiologists and anesthesiologists. The dural tear often occurs at the thoracic or cervical level.
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 skull through. Explain what to expect during an epidural anesthetic. Different mri signs in predicting the treatment efficacy. The current mainstay of treatment is epidural blood patch ebp that forms a dural tamponade to seal csf leaks by injection of the autologous blood into the spinal epidural space. Post dural puncture headache and epidural blood patch on vimeo. Giving you an insight into what its like to go for blood patch surgery. Curative treatment for the csf leak and postdural puncture headache frequently is accomplished with an epidural blood patch. We report the case of a 27yearold woman who developed progressive back pain and radicular symptoms after an ebp was performed for pdph. A novel technique of multiplesite epidural blood patch. Milestone scientifics compuflor epidural instrument. Autoplay when autoplay is enabled, a suggested video will automatically play next. 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.
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. Subsequently, 25 ml solution of 20 ml of autologous blood and 5 ml omnipaque 240 was injected into the epidural space with good spread. The use of fluoroscopy permits the targeting of the site of previous dural puncture or suspected dural leak. Your healthcare provider will inject a sample of your own blood into your back, near the dural puncture site. Ctguided epidural blood patching of directly observed or. The study described in this article utilizes an analogous technique to gauge the therapeutic reproducibility of this novel technique. Epidural blood patch what is an epidural blood patch. Epidural blood patch technique, recovery, and success rate. Injection of fibrin glue mixed with blood into the epidural space to reliably and effectively treat medically refractory orthostatic headache caused by spinal cerebrospinal fluid csf leaks and subsequent intracranial hypotension has recently been described. In this video, you will see my experience in recovery in hospital and at home and.
We sought to evaluate the efficacy of ctguided blood patching of observed or potential csf leaks in spontaneous intracranial hypotension. Ohtonari t1, ota s, nishihara n, ota t, tanaka y, sekihara y, tanaka a. An epidural blood patch is a treatment for spinal headaches. This complication can happen after a spinal tap, an epidural for labor and delivery, or another procedure that requires a spinal puncture. A small number of patients usually less then 10% may need to have a second blood patch. The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture spinal tap. Nonbloodcontaining epidural injections saline, hetastarch, fibrin glue are of limited value because they are invasive, and if an epidural technique is being performed, injecting blood, which is known to work, is a better choice. The case highlights the use of a spinal needle for epidural space confirmation, the importance of waiting for final consultation and radiologic testing results before therapeutic intervention when possible, and the use of an epidural blood patch, even in the setting of a known epidural hematoma.
286 1165 328 621 147 618 1187 687 435 1280 1525 1521 859 349 1337 1102 1577 417 689 129 794 831 420 708 119 753 1507 502 1311 532 684 1061 1073 29 836 459