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