Recent update on epidural blood patch

Abstract

Epidural blood patch (EBP) is the injection of autologous blood into the epidural space with the intent of sealing off a dural tear and stopping the leakage of cerebrospinal fluid (CSF). EBP may cause an increase in intracranial pressure (ICP) due to the mass effect of the injected blood volume, causing CSF from the spinal compartment to enter the intracranial compartment. EBP is usually considered in the management of moderate to severe headache (HA) attributed to low CSF pressure, such as post-dural puncture HA (PDPH), CSF fistula HA, and HA attributed to spontaneous intracranial hypotension (SIH) that does not respond to conservative management. However, prophylactic administration of EBP after accidental dural puncture can hardly be substantiated at present. EBP is generally safe but may rarely be associated with serious complications. Therefore, it should be carefully planned and performed under C-arm fluoroscopic guidance. Although many studies on PDPH and SIH have been conducted until recently, only few reviews have summarized the effectiveness of EBP from the perspective of a pain physician. This article reviews the current literature on the indication, contraindication, procedural consideration, post-procedural management, outcomes, and complications of EBP and the considerations for EBP in patients with COVID-19.

Post-dural Puncture Headache After Removal of Trail Spinal Cord Stimulator Leads: A Case Report

“…Other factors associated with PDPH include low BMI and utility of 14-gauge non-pencil point needle [ 4 ]. While PDPH usually lasts two weeks or less and is self-resolving, its presence can dramatically affect patients’ livelihoods [ 5 ]. Treatment for PDPH ranges from conservative (fluids, non-steroidal anti-inflammatory drugs (NSAIDs), caffeine) to invasive (EBP), which can be pursued earlier if symptomatology is dramatic or conservative measures are not effective [ 6 ].…”

Fluoroscopy-Guided Prophylactic Epidural Blood Patch After Lumbar Puncture in a Patient With a History of Post-Dural Puncture Headache: A Case Report

“…It is important to note that although the novel use of fluoroscopy for prophylactic blood patches can be a safe and effective treatment option for the appropriate patient, it like all procedures does not come without risks. A recent update on EBP (14) discusses the common adverse effects of this procedure which can include headache, backache, neck pain, radicular irritation by blood by-products, and a mild pyretic reaction. Specific to backache, reports indicate an incidence of approximately 80% with resolution by 4 weeks.…”

“…A rebound intracranial hypertension (RIH), caused by an increase in CSF pressure by closure of the CSF leak by the EBP, can also occur and present with headache that is worse in the supine position. If RIH were to occur, the associated headache is often transient and can be treated with acetazolamide or topiramate (14). It is for these reasons why it behooves pain physicians to include in their discussion with patients when obtaining written informed consent for an EBP, a discussion on the risks, benefits, common complications, and alternative treatments in regards to PDPH prevention and treatment.…”

Complete Resolution of Chronic Postdural Puncture Headache from Cervical Decompression After Lumbar Epidural Blood Patch Administration: A Case Report

“…Treatment for PDPH ranges from conservative to invasive measures. In general, PDPH has a benign course, arising usually 24 to 48 hours after dural compromise and is self-limiting (8). Bed rest and hydration tend to be sufficient until its resolution, which tends to occur 2 weeks or less after dural compromise (5,11).…”