Long-Term Follow-Up of Epidural Blood Patch

Abstract

Epidural blood patch (EBP) was performed for the treatment of severe postlumbar puncture cephalalgia in 118 young patients. Following the first EBP, 105 patients had relief of headache. Eleven of the 13 in whom it failed had a second EBP, with adequate relief in 10, giving an overall success of 97.5 percent. Lumbar epidural, caudal, and spinal procedures were successful in 3 patients 105 to 380 days after EBP. Soon after EBP, one patient developed facial paralysis and one complained of episodes of vertigo, dizziness, tinnitus, and ataxia without headaches. Residual complications included backache and/or back stiffness in 22 patients and paresthesia in two. Two-year follow-up revealed 95 percent patient acceptance of the procedure. EBP was found to be a safe, effective method for treating severe postlumbar puncture cephalalgia, provided a proper diagnosis is made and there is no contraindication.

Complications following large-volume epidural blood patches for postdural puncture headache. Lumbar subdural hematoma and arachnoiditis: initial cause or final effect?

“…The most common complaint following EBP is transient low back pain [9]. Rare complications include radicular pain [10], repeat dural puncture, meningitis, cauda equina syndrome [11], neuraxial hematoma, and lumbovertebral syndrome [12].…”

Epidural injection with saline for treatment of postspinal headache: comparison with epidural blood patch

“…Back pain after EBP appeared to occur in 20%-35% of patients, with an average duration of 27 days [16]. The mechanism of back pain remains unclear, but extensive subcutaneous hematoma, nerve root compression by extradural clots, and subarachnoiditis resulting from spread of blood into the subarachnoid space may be causative factors [17].…”

A subdural abscess and infected blood patch complicating regional analgesia for labour

“…Although the presence of fever, infection on the back, coagulopathy and patient refusal are considered to be contraindications to epidural blood patch, interestingly we were unable to find a specific infective complication. 12 The patient we described had been apyrexial since delivery and blood cultures taken as a precautionary measure at the time of the blood patch were negative. We do not routinely check the white cell count before a blood patch, as we are uncertain at what level one would consider an epidural blood patch to be unsafe.…”