Regional Analgesia Following Epidural Blood Patch

Abstract

During the period November 1972 through October 1974, 118 epidural blood patch procedures were performed for severe postlumbar-puncture cephalgia. Subsequently, in a period varying from 105 to 380 days, three patients, two of whom had twice undergone epidural blood patch, were readmitted for either surgical operation or delivery. Either epidural, caudal, or spinal block was successfully accomplished. During the epidural block, the epidural block the epidural space was easily identified and no resistance was felt either to injection of the local anesthetic or to advancement of the epidural catheter. During the spinal block, ligmentum flavum was distinctly felt from the dura. The extent of the blocks, the onset and duration of action ofpivacaine, mepivacaine, and lidocaine were within normal limits. It is, therefore, concluded that epidural blood patch does not obliterate the epidural space and should not preclude the use of regional block for later surgical or obstetric procedures.

Severe spontaneous intracranial hypotension and Marfan syndrome in an adolescent

“…Whether the blood patch affects the efficacy of future epidural analgesia (e.g. in labour) is controversial 33,34 .…”

Peut-on réaliser une analgésie péridurale après un blood patch récent?

“…Bien que le sang soit rapidement résorbé (dès trois heures après la réalisation du BP), le clou plaquettaire reste présent au moins sept jours après [ 2 , 6 ]. En 1975, Abouleish E. et al [ 7 ] ont publié une étude au cours de laquelle ils ont mentionné que la réalisation d'une anesthésie péridurale ou rachidienne chez deux patientes ayant bénéficié d'un blood patch moins de 380 jours auparavant, n'avaient présenté aucun problème.…”

Blood patches may cause scarring in the epidural space: two case reports

“…1 Concerns that organisation of the blood clot may lead to obliteration of the epidural space have been expressed. 9 Early reports of successful blocks up to one year after a blood patch provided some reassurance, 10,11 and a survey of patients up to 12 years after an epidural blood patch found subsequent epidural anaesthesia to be successful in 28 of 29 cases (97%). 12 A review of 300 blood patches in parturients over a 10-year period reported that 17 patients had received epidural anaesthesia in a subsequent pregnancy, in four of whom it was unsatisfactory; these included one further inadvertent dural puncture, one unilateral block, one missed segment block, and one block for caesarean delivery that was too low.…”