Epidural blood patch
Epidural blood patch is a treatment option for patients with craniospinal hypotension or post lumbar puncture headaches. The procedure can be done blind or under fluoroscopic or CT guidance, and is performed predominantly by radiologists and anesthesiologists.
- craniospinal hypotension
- post lumbar puncture headache
- allergy to any of the planned medications
- local or systemic infection
Epidural blood patches can be targeted (i.e. preprocedural imaging has demonstrated the site of CSF leak) or non-targeted 2.
The difference is that the patient has a sterile cannulation prior to, and then the patient's own blood is withdrawn and injected. The volume can be low (2-3 mL) or high (10-20 mL), and can be mixed with contrast to outline the epidural space.
Complications include 3,5:
- transient back pain: most common; pain may last up to 4 weeks 6
- radicular pain
- intrathecal hematoma
- spinal subdural hematoma
- cauda equina syndrome
- spinal epidural abscess
The success rate of non-targeted epidural blood patch is variable, reported between 50-95% for craniospinal hypotension and 90-99% for post lumbar puncture headache. In successful procedures, the patient's symptoms will objectively improve (some only temporarily), and the imaging features of craniospinal hypotension will reverse 1,4,5. Sometimes multiple blood patches are required for a successful outcome.
- 1. Kranz PG, Gray L, Taylor JN. CT-guided epidural blood patching of directly observed or potential leak sites for the targeted treatment of spontaneous intracranial hypotension. AJNR Am J Neuroradiol. 2011;32 (5): 832-8. doi:10.3174/ajnr.A2384 - Pubmed citation
- 2. Agarwal V, Sreedher G, Rothfus WE. Targeted CT-guided epidural blood patch for treatment of spontaneous intracranial hypotension due to calcified intradural thoracic disc herniation. Interv Neuroradiol. 2013;19 (1): 121-6. Free text at pubmed - Pubmed citation
- 3. Gupta D, Amhaz H, Mazumdar A et-al. Transient compressive lumbar radiculopathy following post-epidural blood patch. J Anaesthesiol Clin Pharmacol. 2014;30 (1): 112-4. doi:10.4103/0970-9185.125723 - Free text at pubmed - Pubmed citation
- 4. Schievink WI, Maya MM, Louy C et-al. Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension. AJNR Am J Neuroradiol. 2008;29 (5): 853-6. doi:10.3174/ajnr.A0956 - Pubmed citation
- 5. Atlee JL. Complications in Anesthesia. Saunders. ISBN:1416022155. Read it at Google Books - Find it at Amazon
- 6. Chestnut DH, Wong CA, Tsen LC et-al. Chestnut's Obstetric Anesthesia: Principles and Practice (Chestnut, Chestnut's Obstetric Anesthesia: Principles and Practice). Saunders. ISBN:B00JBSPVHO. Read it at Google Books - Find it at Amazon
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