An epidural blood patch ebp has become standard of care for management of post dural puncture headache and in recent years attempts have been made to expand its applicability. Discomfort occurred in 391 cases 78% after administration of a blood volume of 19 5 ml. Conservative management aims to relieve symptoms while waiting for the dural tear to heal by itself, or to seal the puncture with epidural blood patch. A postural component of headache is the sine qua non of pdph.
Standardizing management of postdural puncture headache. Epidural blood patch cures post dural puncture headache in 90% of cases d. 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. Describe how you would perform an epidural blood patch. In 6070% people who have this kind of headache, the blood patch will cure the headache within 24 hours. However ebp has its own limitations and complicationsthe procedure is involved and requires collection of blood from the patient and injection of the blood into the epidural space. In conclusion, epidural blood patch ebp is effective in the management of postdural puncture headache pdph. Ebp was originally thought to be 90% effective with repeat treatment efficacy approaching 96%.
Epidural blood patching for preventing and treating post dural puncture headache. Postulated reasons for headache following dural tap include. Effects of the serotonin receptor agonist sumatriptan on postdural puncture headache. This feels similar to having the original epidural or spinal injection. Keywords postdural puncture headache, epidural blood patch, complication from epidural placement, management of dural puncture 1.
Often if it is unsuccessful it is due to strain dislodging the clot. This loss of csf may result in a headache due to the loss of the. The mainstay of treatment and the only method borne out in studies to be effective for pdpha is the epidural blood patch. The primary end point was any headache at 24 h after the start of treatment. An epidural blood patch is a procedure used to relieve a headache caused by spinal fluid leak after a dural puncture. Epidural blood patch ebp is a common method for treating postural headache in patients with accidental dural puncture. However ebp has its own limitations and complicationsthe procedure is involved and requires collection of blood from the patient and injection of the blood into the epidural space see discussion section for contraindications of ebp. Seebacher j, ribeiro v, leguillou jl, lacomblez l, henry m, thormann f, youl b, bensimon g, darbois y, bousser mg. Recommendations for treatment with an epidural blood patch are made. Epidural blood patch for the management of postdural puncture headache abdulkadir atim 1, atilla ergin 2, omer yanarates, murat kuyumcu 3, ercan kurt 2 1 beytepe military hospital, department of anesthesiology, ankara 2 gulhane military medical academy, department of aneshesiology, ankara 3 denizli military hospital, department of anesthesiology, denizli. Various treatment modalities have been tried for postdural puncture headache pdph among which epidural blood patch ebp remains as the gold standard.
Longterm effects of ebp on the incidence of backache, headache and early audiometric deterioration are few or. The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture spinal tap. The incidence of accidental dural puncture adp during labor epidural insertion is approximately 1. Postdural puncture headache pdph is a relatively common complication associated with neuraxial anesthesia and unintentional dural puncture. Treatment of postdural puncture headache pdph with an epidural blood patch ebp was first described by gormley in 1960. A post dural puncture headache can be treated with an epidural blood patch. Epidural blood patching for preventing and treating postdural puncture headache.
Epidural blood patch in the treatment of post dural puncture headache. Introduction post dural puncture headache classically presents as a postural headache that occurs after puncture of the dura. Headache is not an uncommon complaint during the postpartum period. Standardizing management of postdural puncture headache in. This feels similar to having the original epidural or. It is postulated that blood injected in the epidural space increases the subarachnoid pressure by causing compression of the thecal sac and forces csf cephalad thereby immediately relieving the headache. Postduralpuncture headache pdph is a complication of puncture of the dura mater one of the membranes around the brain and spinal cord. Controversy still exists over when to perform an ebp, how much blood to inject, and how to manage patients post ebp.
While the classic symptoms of pdpha highlight a positional component that worsens with sitting or standing and improves with lying flat, a small. The incidence of pdph following spinal anaesthesia is dural puncture 2. The epidural blood patch is pretty much a permanent solution if it is successful. Epidural blood patch for the management of postdural. Epidural blood patching ebp remains the gold standard treatment of pdph.
Much of the evidence on obstetric pdph management is not of high quality. Epidural blood patch in post dural puncture headache. The headache is severe and described as searing and spreading like hot metal, involving the back and front of the head and spreading to the neck and shoulders, sometimes involving neck stiffness. In highrisk patients headache is the name for a type of headache that follows a procedure like a spinal tap lumbar puncture or epidural block such as that performed during labor and delivery.
Due to the risk of introducing infectious andor malignant cells into the central nervous system, agents other than a patients own blood should be used in immunocompromised patients with active infections andor circulating. Conventional treatment or epidural blood patch for the treatment of different etiologies of post dural puncture headache. Post dural puncture headache, epidural steroid injection, wet tap, timing of therapy pain physician 2014. Efficacy of a prophylactic epidural blood patch in preventing. We believe this is the first ever 17year retrospective. Epidural bloodpatch ebp is the gold standard treatment when conservative therapy fails, but has significant risks associated. Pathophysiology and management of postdural puncture headache. Keywords post dural puncture headache, epidural blood patch, complication from epidural placement, management of dural puncture 1. Management can be divided into conservative or active in the form of ebp. Epidural blood patch inpatient care what you need to know. The criterionstandard treatment for pdph has been epidural blood patch ebp, but it is an invasive intervention with the potential for severe complications, such as meningitis and paralysis. Epidural blood patch ebp is the gold standard treatment when conservative therapy fails, but has significant risks associated.
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. Epidural blood patch cures postdural puncture headache in 90% of cases d. Management of persistent pdph after repeated epidural blood patch. Successful resolution of headache was achieved with a third ebp performed under computed tomography ct guidance. Abstract 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. Controversy still exists over when to perform an ebp, how much blood to inject, and how to manage patients postebp. Guidelines for the management of post dural puncture. Epidural blood patch ebp is currently the standard treatment for severe post dural puncture headache pdph or for mild cases refractory to conservative measures 1. Efficacy of a prophylactic epidural blood patch in.
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. Treatment of obstetric postdural puncture headache. The incidence of pdph following spinal anaesthesia is 96%. Effectiveness of epidural blood patch in the management of postdural puncture headache. A simple sneeze may dislodge the clot and leaking will resume. Intravenous cosyntropin versus epidural blood patch for. Guidelines for the diagnosis, treatment and prevention of. Longterm effects of accidental dural puncture in patients. Topical sphenopalatine ganglion block compared with.
Prophylactic epidural blood patch when unintentional dural puncture occurs, but before the onset of headache, is not generally recommended, as it is not clearly effective. The autologous epidural blood patch ebp was first shown to be effective in the treatment of these lowpressure headaches in the 1970s. An epidural blood patch may also help reduce other spinal fluid leak. Timing of neuraxial pain interventions following blood. Epidural blood patch for treatment of postdural puncture headache in a patient with spinal fusion and recent implantation of intrathecal pain pump.
The vertebral space where the ebp was performed is depicted in figure 2. Post dural puncture headache pdph is a relatively common complication associated with neuraxial anesthesia and unintentional dural puncture. Epidural blood patch for the management of postdural puncture headache abdulkadir atim 1, atilla ergin 2, omer yanarates, murat kuyumcu 3, ercan kurt 2 1 beytepe military hospital, department of anesthesiology, ankara. To determine the efficacy of epidural blood patch edbp for the treatment of post dural puncture headache pdph. Treatment of postdural puncture headache using epidural. Headache is a common sequela of this procedure irrespective of the indication, although the frequency is less with spinal and epidural anaesthesia where fluid is. Epidural blood patch is more likely to be successful if carried out after 24 h of headache after lumbar puncture. Cosyntropin versus epidural blood patch ebp for treatment. Jan 12, 2012 a careful history can rule out other causes of headache. In most cases, onetwo patches are needed for successful management. Occasionally the epidural blood patch may not take and spinal fluid leakage and headache may persist. In obstetric patients, conservative and pharmacological management of postdural puncture headache pdph is often ineffective. Bed rest after lumbar puncture has a role in preventing headaches after lumbar puncture. A small amount of the patients blood is injected into the epidural space near the site of.
Guidelines for the management of post dural puncture headache. Epidural blood patch technique, recovery, and success rate. Listing a study does not mean it has been evaluated by the u. In 1918 one article published in jama by mac robert rg. Management of persistent pdph after repeated epidural. An epidural blood patch ebp has become standard of care for management of postdural puncture headache and in recent years attempts have been made to expand its applicability. Post dural puncture headache pdph is an iatrogenic cause of patient morbidity in pain management after spinal or epidural anaesthesia, as well as after diagnostic lumbar puncture. Background and objectives postdural puncture headache pdph is a severe and debilitating complication of unintentional dural puncture. Guidelines for placement of epidural blood patch epidural blood patch is used to manage a persistent, incapacitating dural puncture headache.
Epidural blood patch chicago, post dural puncture headache. Introduction postdural puncture headache classically presents as a postural headache that occurs after puncture of the dura. High or total spinal block is discussed separately. Apr 04, 2018 postdural puncture headache pdpha, as defined by the international headache society, is any headache that develops within 5 days of dural puncture and is not better explained by another cause. The aim of this study was to assess both the effectiveness and the predictive factors of failure of ebp on severe postdural puncture headache. It is exacerbated by movement and sitting or standing. We randomised 42 patients who presented with pdph, lasting 24 h to 1 week, to receive edbp n 19 or conservative treatment n 23. Most patients respond to conservative treatment or to epidural blood patch, yet limited options for effective treatment are available for patients who fail these. The anaesthetist takes blood from your arm and injects it into your back, near to the hole in the dura. Epidural blood patching is a wellaccepted therapeutic modality for dural puncture headache. Theophylline for postdural puncture headache abstract. Theophylline for post dural puncture headache abstract. Cosyntropin versus epidural blood patch ebp for treatment of treatment of post dural puncture headache pdph the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. In obstetric patients, conservative and pharmacological management of post dural puncture headache pdph is often ineffective.
Longterm effects of ebp on the incidence of backache, headache and early audiometric deterioration are few or nonexistant. Management of postdural puncture headache radius anesthesia. Guidelines for the management of post dural puncture headache by philip anderson 1 introduction 1. Post dural puncture headache pdph is a complication of puncture of the dura mater one of the membranes around the brain and spinal cord. Effectiveness of epidural blood patch in the management of. Box plot of the time from dural puncture to prophylactic epidural blood patch pebp or sham injection and the total volume of epidural infusate, in subjects with or without a postdural puncture headache pdph. Blood patching should normally be performed only after the first 24 h, as prior to this it is associated with lower success. Inadvertent dural puncturewet tap and pdph management. Prophylactic epidural blood patch after unintentional dural puncture for the prevention of postdural puncture headache in parturients. Your healthcare provider will inject a sample of your own blood into your back, near the dural puncture site. The management of obstetric post dural puncture headache pdph varies considerably. Epidural blood patch is an effective treatment for patients with severe postdural pucnture headache when performed with an appropriate technique and at an appropriate time. Sphenopalatine ganglion block for postdural puncture headache.
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