Injecting a small amount of your blood into the space over the puncture hole will often form a clot to seal the hole, restoring normal pressure in the spinal fluid and relieving your headache. Postdural puncture headache is a leak of cerebrospinal fluid that lowers intracranial pressure and usually presents as a positional headache. Postdural puncture headache pdph is frequently associated with neck, vestibular, cochlear, and ocular symptoms. There is up to a 90% response to a single epidural blood patch. Efficacy of the epidural blood patch for the treatment of post lumbar. 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.
The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture spinal tap. Conventional treatment or epidural blood patch for the treatment of different etiologies of post dural puncture headache. Postdural puncture headache pdph is the most common serious complication in obstetric anesthesia. Efficacy of the epidural blood patch for the treatment of.
Effectiveness of epidural blood patch in the management of postdural puncture headache. This study evaluated the efficacy of iv cosyntropin as an alternative to epidural blood patch ebp for refractory or severe postdural puncture headache pdph. However, use of the word postdural has been criticized as confusing and probably inaccurate, resulting in the proposal of an. Oct 04, 2018 atropine is coadministered to reduce some of the side effects, like bradycardia, nausea, or increased secretions. Guidelines for the management of post dural puncture. A spontaneous csf leak and the clinical syndrome that it causes may be confused with a postdural puncture headache. The reported incidence of postdural puncture headache pdph is up to 40% and typically occurs within the first few days post procedure. Review of the alternatives to epidural blood patch for treat. Postduralpuncture headache an overview sciencedirect topics. 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. Postdural puncture headache pdph is a positional headache ie, worse when the patient sits or stands that usually occurs society guideline links.
These headaches occur from a lumbar puncture that subsequently led to a cerebrospinal fluid leak. Apr 04, 2018 management of postdural puncture headache february 23, 2018 april 4, 2018 radiusanesthesia uncategorized 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. Blood patch minor postdural puncture headache are treated with blood patch treatment. Permanent paraparesis and cauda equina syndrome after. Guidelines for the management of post dural puncture headache. Twentyeight patients were randomized to receive ebp or intravenous cosyntropin after diagnosis with postdural puncture headache. Failure of the second patch and repeating the patch for a third or fourth time has been reported. Epidural blood patch ebp is currently the standard treatment for severe postdural puncture headache pdph or for mild cases refractory to conservative measures 1. Postdural puncture headache and epidural blood patch. Uncontrolled studies report rapid recovery after patching in 90% to 100% of treated patients. Postdural puncture headache pdph is the most common. Discomfort occurred in 391 cases 78% after administration of a blood volume of 19 5 ml. Intravenous cosyntropin versus epidural blood patch for.
The chances of having a spinal headache depend on many factors including age, weight and size of needle used for the procedure. Postdural puncture headache and epidural blood patch the symptoms of a pdph sometimes are not a classic headache but are instead dizziness, auditory changes, visual disturbances, or neck pain that are positional in nature. Postural headaches following interventions that disrupt meningeal integrity are most commonly labeled postdural puncture headaches pdphs. Lumbar puncture is a frequently performed procedure in medical emergencies and anaesthesia. Same time assistant draws blood up to 15 ccs from same individual. 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. Pdph is a relatively frequent complication of dural puncture with an estimated incidence of 2 3% after spinal anesthesia, but as high as 70% after inadvertent dural puncture during an epidural anesthetic. An updated report 2016 american academy of neurology aan. This terminology has been officially adopted in the international classification of headache disorders and is used in this chapter.
Effectiveness of epidural blood patch in the management of. Safatisseront v1, thormann f, malassine p, henry m, riou b, coriat. We show the incidence of accidental dural puncture adp, pdph, epidural blood patch ebp and associated morbidity following a protocol established in an obstetric anesthesia department. Various treatment modalities have been tried for postdural puncture headache pdph among which epidural blood patch ebp remains as the gold standard. An epidural blood patch is a treatment method where a blood sample is taken from a patient and then injected into the epidural space shortly thereafter. Targeted transforaminal epidural blood patch for postdural. A known dural puncture is defined as free flow of cerebral spinal fluid csf during neuraxial placement. Palm springs, california a noninvasive, easytoadminister sphenopalatine ganglion block relieves postdural puncture headache pdph faster than an epidural blood patch in. Blopp blood patch for post dural puncture headache is a randomised, single centre, observerblind clinical trial. Postdural puncture headache is the most frequent complication of major conduction anesthesia and lumbar puncture for diagnostic or therapeutic reasons. Postdural puncture headache and epidural blood patch in a. Palm springs, california a noninvasive, easytoadminister sphenopalatine ganglion block relieves postdural puncture headache pdph faster than an epidural blood patch in obstetric patients. Epidural blood patch in the treatment of post dural puncture headache. Nov 11, 2016 the purpose of this research study is to compare the effectiveness of a sphenopalatine ganglion block to an epidural blood patch for postdural puncture headache relief in randomized postpartum parturients over a 48 hour period.
If you get a spinal headache after a procedure, the anesthesiologist can create a patch with your blood to seal the leak. The authors gave this combo to a patient with postop ileus and pdph, who was scheduled for a blood patch, and noted marked improvement in headache and no need for the blood patch. Post dural punction headache pdph occurs in 10% to 40% of the patients who had a lumbar puncture. Epidural blood patch ebp is indicated for the treatment of postdural puncture headache in people who dont respond to conservative. This terminology has been officially adopted in the international classification of headache disorders and is used in this section. Mar 20, 2015 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. Apr 26, 2018 if your headache hasnt improved within 24 hours, your doctor might suggest an epidural blood patch. Pathophysiology and management of postdural puncture headache. 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. The vertebral space where the ebp was performed is depicted in figure 2. The epidural needle is placed in epidural space at the level where the spinal leakage is suspected. Postdural puncture headache pdph has been a problem for patients, following dural puncture, since august bier reported the first case in 1898. Practitioners of anesthesia are universally aware of postdural puncture headache pdph, yet our understanding of this serious complication remains surprisingly incomplete.
Postdural puncture headache versus spontaneous csf leaks. His paper discussed the pathophysiology of lowpressure headache resulting from leakage of cerebrospinal fluid csf from the subarachnoid to the epidural space. For women who suffer from postdural puncture headache, there is a fast and easy solutionsphenopalatine ganglion block spgb. Management of postdural puncture headache radius anesthesia. Effects of the serotonin receptor agonist sumatriptan on postdural puncture headache. Efficacy of a prophylactic epidural blood patch in preventing post dural puncture headache in parturients after inadvertent dural puncture. Guidelines for the management of post dural puncture headache by philip anderson 1 introduction 1. Sphenopalatine ganglion block effective and safe for.
This headache, called postdural puncture pdph, or lowpressure. Epidural blood patch was performed after a median delay of 4 days range, 153 days after dural puncture. Epidural blood patch for postdural puncture headache due to. The concept of using autologous blood to patch a hole in the meninges was introduced in late 1960 by dr. The epidural blood patch is widely accepted as the treatment of choice for postdural puncture headache. Management of persistent pdph after repeated epidural blood patch.
The epidural blood patch ebp is regarded by many as the goldstandard treatment of postdural puncture headache pdph. 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. This method is commonly used to treat patients with spinal headaches. Epidural blood patch ebp is now recommended as the treatment of choice for managing postdural puncture headache pdph. Treatment of postdural puncture headache in postpartum. When to suspect a csf leak in patients with headache. To put the blood patch in place, the anesthesiologist will. Spinal headaches diagnosis and treatment mayo clinic. Successful resolution of headache was achieved with a third ebp performed under computed tomography ct guidance. Postdural puncture headache and the development of the. If conservative treatments are not successful, the epidural blood patch is the gold standard of the treatment for dural puncture. Last, the evidence behind interventional pain modalities and acupuncture will be examined. Cosyntropin versus epidural blood patch ebp for treatment. We report a case of persistent postdural puncture headache pdph in a patient despite two epidural blood patches ebps.
The procedure can be used to relieve post dural puncture headaches caused. Epidural blood patches are effective for postdural puncture. There is controversy over whether age and gender are independent risk factors for the development of postdural puncture headache. Longterm effects of accidental dural puncture in patients having. Epidural blood patch for treatment of postdural puncture headache in a patient with spinal fusion and recent implantation of intrathecal pain pump. Jul 08, 2017 blood patch minor postdural puncture headache are treated with blood patch treatment. Postdural puncture headache advances in anesthesia. Postdural puncture headache pdph is a relatively common complication after lumbar punctures lp. Postdural puncture headache and the development of the epidural blood patch. Clinical and laboratory research over the last 30 years has shown that use of smallgauge. The interlaminar approach is the most commonly used technique for an epidural blood patch. Epidural blood patch ebp is a common method for treating postural headache in. Management of persistent pdph after repeated epidural. Diazpermanent paraparesis and cauda equina syndrome after epidural blood patch for postdural puncture headache.
The noninvasive block relieves the disabling headache faster than an epidural blood patch ebp, without the trauma of another epidural procedure, according to results from a retrospective analysis. Epidural blood patch ebp is considered the definitive treatment of pdph with a reported success rate of 85%. Headache after lumbar puncture is a common occurrence 32% and carries a considerable morbidity, with symptoms lasting for several days, at times severe enough to immobilise the patient. The technique has a success rate of 7098% if carried out more than 24 h after the dural puncture.
To determine the efficacy of epidural blood patch edbp for the treatment of post dural puncture headache pdph. Theophylline for postdural puncture headache abstract. Epidural blood patch technique, recovery, and success rate. Successful resolution of headache was achieved with a third ebp performed. Post dural puncture headache pdph, also known as post lumbar. Epidural blood patch in post dural puncture headache. If conservative treatment is not sufficient within a few days and the symptoms are severe, an epidural blood patch ebp may be performed. With a postdural puncture headache, a patient usually has a single leak site in the dorsal dura.
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