Epidural blood patch

Epidural blood patches are used to relieve severe, incapacitating or prolonged spinal headaches.


Understanding spinal headaches
Spinal headaches are caused by a leakage of spinal fluid through a puncture hole in the dura (the membrane that surrounds the brain and spinal cord). This leakage causes a decrease in cerebrospinal fluid volume and intracranial pressure, which leads to blood vessel swelling and a headache. These headaches can last one to four days, often starting on the second day after spinal anesthesia or a lumbar puncture (the removal of cerebrospinal fluid for diagnostic purposes). Both of these procedures require doctors to puncture the dura. Multiple punctures, larger needles and the use of certain types of needles increase the risk of developing a spinal headache after spinal anesthesia or a lumbar puncture.
Spinal headaches vary in intensity from mild to incapacitating. The pain often occurs or worsens when you sit up or stand. It may decrease or go away when you lie down or move or raise your head. Often, doctors treat spinal headaches with conservative measures first, such as painkillers, lying flat and drinking plenty of fluids. Some also suggest that caffeine may help alleviate the pain associated with spinal headaches. If these measures fail, a blood patch may relieve the headache. It's thought that the blood patch works by stopping the leakage of spinal fluid by sealing the opening in the dura and allowing normal cerebrospinal fluid pressures.


Preparation
Before the procedure, you'll empty your bowel and bladder. Fasting and sedation aren't necessary. During the procedure, you must remain perfectly still. Any movement may cause injury.

Procedure
You'll be positioned on your side with your knees pulled up tightly against your chest. If you prefer sitting up for the procedure, your doctor may allow you to sit on a bed with your torso curled over and resting on an object such as a bedside stand for support. Next, 10 to 20 milliliters of blood will be drawn from your arm while the anesthesiologist, pain specialist or neurologist accesses the epidural space. The blood will then be injected into the space over the hole in the dura.

Postprocedure care
You'll rest for 30 to 60 minutes after the procedure.

Benefits
An epidural blood patch promptly relieves the pain of a spinal headache. The success rate is generally greater than 90 percent.

Risks
Risks associated with an epidural blood patch may include:

occasional feelings of numbness, prickling or tingling
pain along the nerve root
back pain and stiffness
neck pain
dizziness
abdominal cramping
acute aseptic or bacterial meningitis (inflammation of the spinal cord or brain membranes)
local infection
abscess formation (collection of pus)
rarely, subdural hematoma (a blood clot beneath the dura)

Considerations
People who have blood-clotting disorders, infections in the area of the epidural injection or widespread infections are not candidates for an epidural blood patch.