Efficacy of epidural blood patch for postdural puncture headache

Abstract

This prospective investigation was conducted to evaluate the efficacy of different volumes of epidural blood patch (EBP) for treatment of postdural puncture headache (PDPH) in 81 consecutive patients. In the first part of the investigation (Study part I), 10 ml of blood was injected for EBP in 28 patients. In the second randomized part of the investigation (Study part II), the patients were allocated to receive for EBP either 10 ml (27 patients) or 10-15 ml (26 patients), according to the height of the patient. The procedure was considered initially successful if PDPH disappeared completely during the 2-h recovery room follow-up. To evaluate the long-term success, a questionnaire was mailed to all patients. The EBP performed 3.7 +/- 2.9 days following the dural puncture was initially successful in 88-96% of the patients in the different study groups. In the questionnaire, only 50-68% of the patients reported that PDPH had disappeared immediately without recurrence. In 16-36% of the patients the PDPH returned at lesser intensity and in 14-17% PDPH was reported to have continued, disappearing gradually in all patients. Despite this, 87% of all patients were satisfied with the EBP treatment. There were no statistically significant differences between the groups. The results indicate that a larger, height-adjusted volume of blood for EBP in adults does not produce a better effect on PDPH compared to a standard 10-ml volume. Despite the excellent initial effect (91%) seen in our patients, a permanent effect of the blood patch was only achieved in 61%.

Post-dural puncture headaches in children. A literature review

“…It consists of injecting a small amount of autologous blood into the epidural space, as close as possible to the site of the dural puncture, either at the same or at a lower interspace [11,27,36]. Standard volume is 10-15 ml autologous blood [7,22,32]. After application of an EBP, patients should lie flat for at least 1 h, but preferably 2 h [7,22].…”

“…For patients with persistent symptoms, different treatment regimens are discussed in the literature. The EBP, first described by Gormley in 1960 [27,32], is one of the most effective methods [5,7,11,13,31,36]. It consists of injecting a small amount of autologous blood into the epidural space, as close as possible to the site of the dural puncture, either at the same or at a lower interspace [11,27,36].…”

“…Application of an EBP is successful in 75%-96% of patients. If the first EBP fails, a second may be successful [1,7,8,23,31,32,36].…”

“…Of the 40 articles to which we refer and which were published between 1990 and 2002, 9 review existing literature and refer to numerous studies but often do not mention how many patients are included in the studies [5,7,8,10,11,13,15,23,34]. Twenty-one articles are prospective studies, referring to other studies in the discussion [3,6,9,12,14,16,17,18,19,20,21,22,25,28,32,33,35,37,38,39,41]; four are retrospective studies [1,26,31,40], three are case reports followed by literature review [4,27,36]; two editorials [2,29] and one is a letter [30].…”

Post-Epidural Headache: How Late Can It Occur?

“…One study reported that, although immediate relief occurred in almost all patients, long-term pain relief was achieved in only 61% of patients. 10 It is not entirely clear how an EBP works. An increase in cerebrospinal pressure or reflex cerebral vasoconstriction are likely explanations.…”