A randomised, observerblind, controlled clinical trial. The epidural blood patch consists of an injection of 1020 ml of autologous blood into the lumbar epidural space. Uncontrolled studies report rapid recovery after patching in 90% to 100% of treated patients. Autologous epidural blood patch aebp is effective for postduralpuncture headache pdph. Inadvertent dural puncturewet tap and pdph management. We randomised 42 patients who presented with pdph, lasting 24 h to 1 week, to receive edbp n 19 or conservative treatment n 23. Background and objectives the gold standard for the treatment of postdural puncture headache pdph is the epidural blood patch ebp. If headache is severe and persistent, an epidural blood patch is recommended. Levi v1, di laurenzio ne1, franzini a1, tramacere i2, erbetta a3. This headache is often described as a headache like no other, being more severe when the patient is. The efficacy of tetracosactide for the treatment of pdph in 32 patients has been reported to be 56% 95% ci 33. Background lumbar epidural blood patch ebp is a common treatment of postdural puncture headache, but its effectiveness and mode of action remain a matter of debate. Optimal diagnosis and management of spontaneous intracranial hypotension remains uncertain. Epidural blood patch an overview sciencedirect topics.
The autologous epidural blood patch ebp was first shown to be effective in. Sih, empiric epidural blood patch has been shown to be effective in. Injectate volume was variable and guided by the onset of back pain, radiculopathy or symptoms referable to the ebp. Researchers are gaining more insight into the factors that best predict the efficacy of an epidural blood patch in patients with spontaneous cerebrospinal fluid hypovolemia. Epidural blood patch is currently the gold standard and most effective treatment for pdph.
Effectiveness of lidocaine patch 5% lidoderm in the treatment of low back pain lbp. Bed rest and oral analgesics, although of limited efficacy, are firstline therapy, and. Materials and methods from november 20 to april 2017, a total of 164 patients 76 males, 88 females, mean age 40. Prophylactic epidural blood patch after unintentional dural. Recently, however, efficacy has been found to be lower 32% at most 27. Epidural blood patch is an effective treatment of severe postdural puncture. Argoff c, nicholson b, moskowitz m, wheeler a, gammaitoni a.
It has been concluded that caffeine is an effective therapy for pdph18,19. Autologous epidural blood patch aebp is the main stay of treatment of pdph when it is not relieved with conservative management. Efficacy of a prophylactic epidural blood patch in preventing post dural puncture headache in parturients after inadvertent dural puncture. Post dural punction headache pdph occurs in 10% to 40% of the patients who had a lumbar puncture. A randomized, observerblind, controlled clinical trial. This is accentuated by the lack of properly performed studies. Is the overall success rate of spinal epidural corticosteroid injections good. Our study design not only enables us measure the effectiveness of the edbp, but also its efficiency.
Lumbar epidural steroid injections for low back pain and. Carrie and collins define a pdph as a headache occurring after dural puncture that has a. Effectiveness of epidural blood patch in the management of postdural puncture headache 1. Epidural blood patch ebp is currently the standard treatment for severe postdural puncture headache pdph or for mild cases refractory to conservative measures 1.
The primary end point was any headache at 24 h after the start of treatment. Efficacy of the first epidural blood patch according to timing. Postdural puncture headache and epidural blood patch. Your healthcare provider will inject a sample of your own blood into your back, near the dural puncture site. Efficacy of a prophylactic epidural blood patch in preventing postdural puncture headache in parturients after inadvertent dural puncture. Factors predicting response to the first epidural blood patch in spontaneous intracranial hypotension. In some cases, repeat procedures are required for complete cure. An epidural blood patch may also help reduce other spinal fluid leak. Scavone b, wong c, sullivan j, yaghmour e, sherwani s, mccarthy r. There are no case reports of a blood patch for csf leaks secondary to. Its effectiveness is decreased if dura mater puncture is caused by a large.
This quickly led to resolution of the headache and cranial nerve palsies, and later to the complete resolution of his sdh. Postdural puncture headache is common in parturients following lumbar puncture. Timing of epidural blood patch wiley online library. Effectiveness of epidural blood patch in the management of. We commonly use ebp for headache secondary to a dural puncture during insertion of an epidural catheter.
Withholding safe, efficacious treatment from a patient who is suffering. Epidural blood patch was performed after a median delay of 4 days range, 153 days after dural puncture. Effectiveness of spinal epidural corticosteroid injections. Ema effectiveness of epidural blood patch in the management. To determine the efficacy of epidural blood patch edbp for the treatment of post dural puncture headache pdph.
Efficacy of the epidural blood patch for the treatment of. Ebp was originally thought to be 90% effective with repeat treatment efficacy approaching 96%. Prophylactic epidural blood patch after unintentional. Methods this prospective observational study includes all patients treated in the. We present a case of neurologically complicated aebps, one of which was performed at the interspace of unintentional dural puncture udp. Dec 28, 2017 the epidural blood patch is currently the goldstandard treatment for postdural puncture headache, however it is an invasive procedure with possible risks and complications including bleeding, infection, pain, hematoma, neurologic complications, and repeat dural puncture. There was a strong and positive correlation between blood volume and pain reduction. Despite a high success rate at the 1st attempt with a blood patch of up to. A spinal headache may occur up to 5 days after the lumbar puncture. In the case of a cervical or dorsal blood patch, ct guidance is recommended, which ensures epidural application of the blood patch and minimizes the risk of damaging the spinal cord. Additionally, the need for a second blood patch is classified as failure in these investigations 15, 17, but obstetric patients commonly have an initial response to a blood patch followed by recurrence of symptoms after several days, and up to 28% of parturients undergoing therapeutic epidural blood patch after accidental dural puncture. Our objective was to evaluate the efficacy of these peripheral nerve blocks pnbs. 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.
The efficacy of a fluoroscopy guided epidural autologous. The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture spinal tap. The volume injected displaces cerebrospinal fluid csf from the lumbar csf space into the area surrounding the brain, often yielding immediate. This cross sectional study was conducted in the department of anesthesia and intensive care nishtar hospital, multan and bahwal victoria hospital bahwalpur from august 2018 to april 2019. Blopp blood patch for post dural puncture headache is a randomised, single centre, observerblind clinical trial. As stated earlier, an accurate diagnosis is most important. Although many studies document the shortterm benefits of epidural steroid injections, the data on longterm effectiveness are less convincing. Indeed, the effectiveness of lumbar epidural steroid injections continues to be a topic of debate. Background we report a retrospective analysis of a twolevel, variablevolume epidural blood patch ebp technique for the treatment of spontaneous intracranial hypotension sih. Effectiveness did not vary by the spinal level of injection p 0. Epidural blood patch in post dural puncture headache.
An assessment of prophylactic epidural blood patching. Regional techniquessphenopalatine ganglion block spgb, greater occipital nerve block gonb and trigger point infiltration tpican also be used for the treatment of pdph. Higher success rate was achieved with higher volume of epidural blood patch in the patients with spontaneous intracranial hypotension. The aim of this study was to assess both the effectiveness and the predictive factors of failure of ebp on severe postdural puncture headache. More recent report of large volume epidural blood patches 2017 wu jw, hseu ss, fuh lj, lirng jf, wang yf, chen wt, wen sp, wang sj. In rare instances, severe adverse effects can occur. 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. Intravenous cosyntropin versus epidural blood patch for. 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 influence of timing on the effectiveness of epidural blood. Related issues have also generated con troversy, including whether or not an epidural blood patch should be performed in a febrile patient. To describe the efficacy of aebp in treatment of pdph. However, the timing for this treatment remains uncertain.
Postdural puncture headache in the obstetric population. Additionally, the need for a second blood patch is classi. Background and objective epidural blood patch ebp is a safe and effective treatment for spontaneous intracranial hypotension sih, but clinical and procedural variables that predict ebp efficacy remain nebulous. In my clinical experience, epidural corticosteroid injections are very effective to help relieve pain and paresthesias in patients with spinal radiculopathies caused by disc herniation. Epidural patching medical clinical policy bulletins aetna. Epidural blood patch after thoracotomy for treatment of. Case report epidural blood patch for postdural puncture position vertigo. Ctguided epidural blood patching of directly observed or. Prevention is key but an epidural blood patch is standard treatment in. Safatisseront v, thormann f, malassine p, henry m, riou b, coriat p, seebacher j. Jun 27, 2016 the aim of the study is to assess the efficacy and safety of synacthene versus placebo in the treatment of postdural puncture syndrome in patients receiving epidural analgesia, spinal analgesia, or combined spinalepidural analgesia for labour. Efficacy of the epidural blood patch for the treatment of post lumbar puncture headache blopp. An epidural blood patch ebp was performed, and the patient reported complete relief of the headache. Therapeutic epidural blood patch is the treatment of choice for severe.
Efficacy of epidural blood patch for postural puncture. Review of the alternatives to epidural blood patch for treat. 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. The sphenopalatine ganglion block for postdural puncture. Factors that affect the efficacy of epidural blood patch.
In one study, the success rate of epb in a heterogeneous population that included parturients was 75%. The epidural blood patch is widely accepted as the treatment of choice for postdural puncture headache. For the same reasons as well as due to the procedural limitations of blind placing of the epidural blood patch that may or may not effectively seal the dal and. The influence of timing on the effectiveness of epidural. Procedural predictors of epidural blood patch efficacy in. The chances of having a spinal headache depend on many factors including age, weight and size of needle used for the procedure. Epidural blood patch technique, recovery, and success rate. The mean spread of the blood patch in the epidural space has been found to be 4. Efficacy of the first epidural blood patch based on needle size. An epidural blood patch is a procedure used to relieve a headache caused by spinal fluid leak after a dural puncture. Effectiveness of epidural blood patch in the management of postdural puncture headache. We sought to evaluate the efficacy of ctguided blood patching of observed or potential csf leaks in spontaneous intracranial hypotension. The epidural blood patch is currently the goldstandard treatment for postdural puncture headache, however it is an invasive procedure with possible risks and complications including bleeding, infection, pain, hematoma, neurologic complications, and repeat dural puncture. Permanent relief was more likely to be achieved if epidural blood patch performed after 48 h p 0.
Discomfort occurred in 391 cases 78% after administration of a blood volume of 19 5 ml. Efficacy of a prophylactic epidural blood patch in. Lumbar epidural blood patch ebp is a common treatment of postdural puncture headache, but its effectiveness and mode of action remain a matter of debate. The aim of this study was to evaluate the efficacy of epidural fibrin glue for treatment of severe pdph in comparison to epidural blood patch ebp.
To evaluate the efficacy of a fluoroscopyguided epidural blood patch ebp in the treatment of a postdural puncture headache pdph. The procedure carries an initial success rate of greater than 90%. Some studies have suggested a greater risk of failure when administering an early blood patch, although no causal link could be established 2628. Efficacy of the epidural blood patch for the treatment of post.
In this case the epidural blood patch is the treatment of choice. Although epidural blood patch is the best treatment, there are some patients in whom this treatment is refused or contraindicated. Dec 31, 20 autologous epidural blood patch aebp is the main stay of treatment of pdph when it is not relieved with conservative management. He was able to show presence of blood in the epidural space at the cervical levels on postprocedure mris. A small amount of the patients blood is injected into the epidural space near the site of. Methods ninetyfour patients with sih underwent ebps. Timing of ebp may influence therapeutic effectiveness in some patients. Efficacy of a prophylactic epidural blood patch in preventing. Ctguided blood patching has been described but has not been evaluated in larger case series. The autologous epidural blood patch ebp was first shown to be effective in the treatment of these lowpressure headaches in the 1970s. Repeat epidural blood patch at the level of unintentional. The literature assessing the use and safety of epidural blood patch in the elderly is sparse.
Epidural blood patch refractory low csf pressure headache. A twolevel largevolume epidural blood patch protocol for. Epidural blood patch definition of epidural blood patch by. What is the efficacy of epidural steroid injections in the. The syndrome is most effectively treated with placement of an epidural blood patch, performed by inserting 10 to 20 ml of autologous blood into the epidural space in proximity to the level of the dural puncture. Prevention is key but an epidural blood patch is standard treatment in postdural puncture headache. Epidural blood patch inpatient care what you need to know.