PDF
ePub
Citation
Print
Abstract
Purpose
To evaluate the efficacy of a fluoroscopy-guided epidural blood patch (EBP) in the treatment of a post-dural puncture headache (PDPH).
Materials and Methods
From November 2013 to April 2017, a total of 164 patients (76 males, 88 females, mean age 40.7 years, age range 12 to 87 years) underwent a fluoroscopy guided EBP for the treatment of PDPH in the department of radiology. The treatment outcomes were classified as follows: complete relief, incomplete relief, failure, and recurrence. In the case of recurrence, the duration between the date of the first EBP and the date of recurrence was described. The effectiveness of the second EBP was also evaluated.
Results
In 164 PDPH patients, complete relief was achieved in 157 patients (95.8%), incomplete relief was achieved in 1 patient (0.6%), failure in 2 patients (1.2%) and recurrence in 4 patients after the first EBP. All 4 recurrence patients and the 2 failure patients were discharged with complete relief after receiving one additional EBP.
References
1. Jabbari A, Alijanpour E, Mir M, Bani Hashem N, Rabiea SM, Rupani MA. Post spinal puncture headache, an old problem and new concepts: review of articles about predisposing factors. Caspian J Intern Med. 2013; 4:595–602.
2. Brownridge P. The management of headache following accidental dural puncture in obstetric patients. Anaesth Intensive Care. 1983; 11:4–15.
3. Bezov D, Ashina S, Lipton R. Postdural puncture headache: part II–prevention, management, and prognosis. Headache. 2010; 50:1482–1498.
4. Banks S, Paech M, Gurrin L. An audit of epidural blood patch after accidental dural puncture with a Tuohy needle in obstetric patients. Int J Obstet Anesth. 2001; 10:172–176.
5. Safa-Tisseront V, Thormann F, Malassiné P, Henry M, Riou B, Coriat P, et al. Effectiveness of epidural blood patch in the management of post-dural puncture headache. Anesthesiology. 2001; 95:334–339.
6. Taivainen T, Pitkänen M, Tuominen M, Rosenberg PH. Efficacy of epidural blood patch for postdural puncture headache. Acta Anaesthesiol Scand. 1993; 37:702–705.
7. van Kooten F, Oedit R, Bakker SL, Dippel DW. Epidural blood patch in post dural puncture headache: a randomised, observer-blind, controlled clinical trial. J Neurol Neurosurg Psychiatry. 2008; 79:553–558.
8. Vercauteren MP, Hoffmann VH, Mertens E, Sermeus L, Adri-aensen HA. Seven-year review of requests for epidural blood patches for headache after dural puncture: referral patterns and the effectiveness of blood patches. Eur J Anaesthesiol. 1999; 16:298–303.
9. Williams EJ, Beaulieu P, Fawcett WJ, Jenkins JG. Efficacy of epidural blood patch in the obstetric population. Int J Obstet Anesth. 1999; 8:105–109.
10. Watanabe K, Hashizume K, Kawaguchi M, Fujiwara A, Sasaoka N, Furuya H. Fluoroscopically guided epidural blood patch with subsequent spinal CT scans in the treatment of spontaneous cerebrospinal fluid hypovolemia. J Neurosurg. 2011; 114:1731–1735.
11. DiGiovanni AJ, Galbert MW, Wahle WM. Epidural injection of autologous blood for postlumbar-puncture headache. II. additional clinical experiences and laboratory investigation. Anesth Analg. 1972; 51:226–232.
12. Gormley JB. Treatment of post-spinal headache. Anesthesiology. 1960; 21:565–566.
13. Oedit R, van Kooten F, Bakker SL, Dippel DW. Efficacy of the epidural blood patch for the treatment of post lumbar puncture headache BLOPP: a randomised, observer-blind, controlled clinical trial [ISRCTN 71598245]. BMC Neurol. 2005; 5:12.
14. Rice GG, Dabbs CH. The use of peridural and subarachnoid injections of saline solution in the treatment of severe post-spinal headache. Anesthesiology. 1950; 11:17–23.
15. Jeon JK, Choi KT. Epidural blood patch for post lumbar puncture headache. Korean J Anesthesiol. 1988; 21:863–871.
16. Chen IW, Lin CM. Fluoroscopy-guided caudal epidural blood patch for relieving post-dural puncture headache after lumbar spine surgery. Egy J Anaesth. 2017; 33:133–135.
17. Kawaguchi M, Hashizume K, Watanabe K, Inoue S, Furuya H. Fluoroscopically guided epidural blood patch in patients with postdural puncture headache after spinal and epidural anesthesia. J Anesth. 2011; 25:450–453.
18. Bhandari A, Anand A, Khan F, Ellias M. Epidural blood patch: comparison of fluoroscopic guided technique versus non-fluoroscopic (blind) technique. The Pain Clinic. 2001; 13:77–82.
19. Tekkök IH, Carter DA, Brinker R. Spinal subdural haematoma as a complication of immediate epidural blood patch. Can J Anaesth. 1996; 43:306–309.
20. Sperry RJ, Gartrell A, Johnson JO. Epidural blood patch can cause acute neurologic deterioration. Anesthesiology. 1995; 82:303–305.
21. Yoon SH, Lee JW, Lee GY, Lee E, Kang HS. Comparison of the efficacy of epidural autologous blood patch in the treatment of spontaneous intracranial hypotension and postdural puncture headache. J Korean Soc Radiol. 2014; 70:299–305.
22. Hayek SM, Fattouh M, Dews T, Kapural L, Malak O, Mekhail N. Successful treatment of spontaneous cerebrospinal fluid leak headache with fluoroscopically guided epidural blood patch: a report of four cases. Pain Med. 2003; 4:373–378.
23. Fry RA, Perera A. Failure of repeated blood patch in the treatment of spinal headache. Anaesthesia. 1989; 44:492–493.
24. Loeser EA, Hill GE, Bennett GM, Sederberg JH. Time vs. success rate for epidural blood patch. Anesthesiology. 1978; 49:147–148.
25. Ho KY, Gan TJ. Management of persistent post-dural puncture headache after repeated epidural blood patch. Acta Anaesthesiol Scand. 2007; 51:633–636.
Fig. 1.
Epidural blood patch is done at L2/3 (A), L3/4 (B), and L4/5 (C) using 10 mL autologous blood.
Table 1.
Demographics and EBP of 164 Patients with Post Lumbar Puncture Headache
| Variable | n (%) |
|---|---|
| Gender | |
| Female | 88 (54) |
| Male | 76 (46) |
| Age (year) | |
| < 20 | 15 (9) |
| 20–40 | 73 (45) |
| 40–60 | 58 (35) |
| > 60 | 18 (11) |
| EBP Level | |
| L2/3 | 5 (3) |
| L3/4 | 148 (87) |
| L4/5 | 17 (10) |
| Post EBP complication | 0 (0) |
Table 2.
Cases of Failure/Recurrence after First EBP in Patients with Post Lumbar Puncture Headeache
XML Download