Epidural blood patches for post-dural puncture headache
Epidural blood patches:
• PDPH = post dural puncture headache
• Blood patch is most effective therapy for PDPH
• Complications of dural puncture can be serious:
. – Arachnoiditis
. – Meningitis
. – Intracranial hypertension
. – Cauda equina syndrome
. – Bradycardia
. – Pneumocephalus
. – Subarachnoid hematoma
. – Two patients had facial nerve palsy
. – One patient had tinnitus and vertigo
• PDPH can be resistant to therapy with EBP
• Other causes of post-partum headache include:
. – Preeclampsia
. – Meningitis
. – Superior sagittal sinus thrombosis
. – Intracranial bleeding
. – Space-occupying lesions
• The ‘other’ causes usually don’t worsen in the upright position
• Atypical headaches, even if somewhat postural, are usually not PDPH
• If headaches don’t resolve with EBP, X-rays are indicated
• Use 20 ml of the patient’s own blood
• 20% of patients will have mild backache for a few days after EBP
• Two modes of action:
. – Plugs the hole
. – Decreases the spinal volume which erases the CSF deficit
• If a catheter has been threaded into the intrathecal space via an epidural needle, the catheter should be left in place for 24 hours after delivery. Then, 10-15 ml of sterile saline should be injected through the catheter just before taking it out.
• Prevention of PDPH:
. – Women 20 to 40 years of age are highly prone
. – Use 25 gauge Whitacre needle for spinals
. – Orient the needle parallel to fibers
• Treatment of PDPH:
. – Be certain of diagnosis
. – Start with bed rest and analgesics
. – Next, try IV bolus of 500 mg caffeine sodium benzoate in 1 liter fluid over one hour; this may be repeated if headache persists after 3 hours
. – EBP is next
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