Epidural Blood Patch

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Epidural Blood Patch 2016-11-17T09:53:48+00:00

What Is An Epidural Blood Patch?

An epidural blood patch is a procedure in which a blood sample is taken from a patient and then injected back into the epidural space. This method is performed to treat patients suffering from spinal headaches and it was used for the first time in 1960. Spinal headaches may also be referred to as chronic post dural puncture headaches. This form of headache develops in 10-40% of individuals who receive lumbar punctures to treat certain medical conditions.

The epidural space, which is a sac that encases the spinal cord, contains cerebrospinal fluid. This fluid circulates from the spine to the brain and if a lumbar puncture causes it to leak, pressure in the brain begins to decrease. An epidural blood patch restores the optimal pressure in the brain by sealing the leak.

How Is An Epidural Blood Patch Performed?

hardware block procedureBefore the epidural blood patch procedure begins, about 15 to 20 milliliters of blood is drawn from the patient. Next, the patient receives an injection containing an anesthetic in order to numb the targeted region. The blood that was withdrawn is then injected with an epidural needle into the area where the leak was discovered. The injected blood gradually begins to clot and this forms a seal over the leak. The patch procedure usually takes 30 minutes.

It has been reported that most people experience relief after the epidural blood patch treatment that is almost immediate. However, the procedure can be repeated if pain relief is not experienced the first time. This procedure only needs to be repeated in about 5% of all cases. A recently published study regarding the use of the epidural blood patch to treat headaches showed that this method leads to a significant decrease in the duration and intensity of headaches. These results indicate that this treatment approach is still a viable option for people who experience post-dural puncture headaches.

This treatment method is minimally invasive, but it is associated with certain complications. Nerve damage, headaches, an infection, abdominal cramping, and bleeding are complications that may occur due to an epidural blood patch, though the occurrence of these is rare. Some patients have also reported feeling discomfort and mild pain for several days after undergoing this procedure.

Conditions Related To An Epidural Blood Patch

Migrain headacheWhen headaches become chronic, people usually seek medical advice. Persistent headaches may develop due to a number of conditions so clinicians generally try to determine what the primary cause is through the use of imaging tests and different clinical assessments. A lumbar puncture may lead to spinal headaches and this factor has to be considered if a person reports having a history of spinal injection procedures. Injections may have been administered to the spine for the following purposes:

  • Pain management (e.g., epidural injection)
  • An epidural to assist with labor
  • Spinal anesthesia for surgery
  • A myelogram (Contrast dye is administered to the spinal cord during imaging screening)

If an individual who is suffering from persistent headaches mentions having undergone one or more of these spinal injections in the past, then cerebrospinal fluid may be leaking and responsible for the pain. A 10% loss of cerebrospinal fluid is enough to cause a spinal headache. This particular form of spinal headache has been studied repeatedly. One specific study showed that post-dural puncture headaches develop in 16-86% of individuals who have received epidural injections for which large bore needles were used.

headache and fibromyalgiaFurthermore, the International Headache Society refers to a headache that presents itself approximately seven days after a spinal injection and intensifies while sitting in an upright position for about ten minutes as a post-dural puncture headache. Vomiting, neck stiffness, and nausea are additional symptoms that may occur during the headache.  Individuals who lay down for 30 minutes usually report experiencing relief. Women who were given an epidural to assist with their labor and individuals whose ages range from 18 to 30 have the highest incidence of these headaches.

Research has repeatedly indicated that an epidural blood patch is a standard form of treatment for spinal headaches that develop due to lumbar injections that cause unexpected puncture wounds. However, current studies have also assessed the ability of epidural blood patches to effectively treat headaches that developed after patients received an implantation with an intrathecal pain pump, or underwent spinal fusions. According to clinical reports, an epidural blood patch typically results in positive outcomes for patients who suffer from headaches after undergoing both of the aforementioned treatment methods.

In addition, one particular case study that was recently published showed that epidural blood patches can be used to effectively treat a patient who had lumbar puncture-induced vertigo. The patient did not report experiencing any headaches although the vertigo was significant. However, the dizzy spells as well as all the symptoms related to the vertigo that were initially reported immediately disappeared after the epidural blood patch was performed.

Conclusion

An epidural blood patch is a treatment method where a blood sample is taken from a patient and then injected into the epidural space shortly thereafter. This method is commonly used to treat spinal headaches that were caused by a lumbar puncture and subsequently led to the leakage of cerebrospinal fluid. Epidural blood patches seal leaks and restore the optimal pressure in the brain and in doing so effectively treat lumbar puncture-related conditions. This treatment method is minimally invasive and it usually takes 30 minutes to complete. Epidural blood patches have consistently demonstrated the ability to provide patients with significant relief.

References

  1. Ahmed G, Arjang K, Mangar D. Post-dural puncture headache. Int J Gen Med. 2012;5:45-51.
  2. Burnett C, White A, Vulcan M. Epidural Blood patch for treatment of postdural puncture headache in a patient with spinal fusion and recent implantation of intrathecal pain pump. Op J Anesth. 2013;3:168-169.
  3. Kokki M, Sjovall S, Keinanen M, Kokki H. The influence of timing on the effectiveness of epidural blood patches in parturients. Int J Ob Anesth. 2013;22:303-309.
  4. Madsen S, Fomsgaard J, Jensen R. Epidural blood patch refractory low CSF pressure headache: a pilot study. J Headache Pain. 2011;12:453-457.
  5. Oedit R, Van Kooten F, Bakker SLM, Dippel DWJ. Efficacy of the epidural blood patch for the treatment of post lumbar puncture headache BLOPP: A randomized, observer-blind, controlled clinical trial. BMC Neurol. 2005;5:12.
  6. Vazquez R, Johnson D, Ahmed S. Case Report – Epidural blood patch for postdural puncture position vertigo. Pain Medicine. 2011;12:148-151.

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