Epidural blood patch for the treatment of post dural puncture headache in pregnant women

Abstract

Objective: Postdural puncture headache (PDPH) is still a considerable problem and it is one of the most common complications of neuro axial anesthesia. Efficiency of the blood patch performed for the patients who developed postdural headache following spinal and combined spinal-epidural anesthesia carried out in our hospital was retrospectively investigated. Material and Methods: Postdural puncture headache (PDPH) is one of the complications commonly encountered after epidural anesthesia and analgesia with occurring of dural penetration. In this study, efficiency of the epidural blood patch (EBP) was discussed in the patients with postdural puncture headache who did not give response to medical therapy. A total of 55 patients who developed PDPH following caesarean section performed under spinal and combined spinal-epidural anesthesia between January 2009 and January 2014 in Erzincan State Hospital and Erzincan Mengücek Gazi Training and Research Hospital was included in the study. Results: Among the 1,110 undergone spinal and 1,749 combined regional anesthesia patient, 55 patients have been developed PDHA and 34 patients who did not give response to medical therapy who applied epidural blood patch. Conclusions: In the cases of PDPHs which don’t give response to medical therapy within 24 hours, EBP should be administered, considering not only the mothers, but also the infants.

Keywords

• Epidural blood patch,post dural puncture headache,caesarean section

References

1. 1. Evans RW, Armon C, Frohman EM, Goodin DS. Assessment: prevention of post-lumbar puncture headaches. Report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology 2000; 55: 909-914.
2. 2. Bezov D, Lipton RB, Ashina S. Post-dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiology. Headache 2010; 50: 1144-52.
3. 3. Vallejo MC, Mandell GL, Sabo DP, Ramanathan S. Postdural puncture headache: a randomized comparison of five spinal needles in obstetric patients. Anesth Analg 2000; 91: 916-20.
4. 4. Hess JH. Postdural puncture headache: a literature review. AANA J 1991; 59: 549-55.
5. 5. Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth 2003; 91: 718-29.
6. 6. Morgan GE, Mikhail MS, Murray MJ, Larson CP. Regional Anesthesia&Pain Management. In: Morgan GE, editor. Clinical Anesthesiology. 3rd edition. Los Angeles: The McGraw-Hill Companies; 2002. pp. 253-344.
7. 7. Szeinfeld M, Ihmeidan IH, Moser MM. Epidural blood patch: evaluation of the volume of spread blood injected into the epidural space. Anesthesiology 1986; 64: 820.
8. 8. Güldoğuş F, Kelsaka E. The epidural blood patch technique for the management of headache due to spontaneous intracranial hypotension. AĞRI 2013; 25: 137-140

9. 9. Palahniuk RJ, Cumming M. Prophylactic blood patch does not prevent post lumbar puncture headache. Can Anaesth Soc J 1979; 26: 132-133.
10. 10. Vilming ST, Kloster R, Sandvik L. When should an epidural blood patch be performed in postlumbar puncture headache? A theoretical approach based on a cohort of 79 patients. Cephalalgia 2005; 25: 523-527.
11. 11. Loeser EA, Hill GE, Bennett GM, Sederberg JH. Time vs success rate for epidural blood patch. Anesthesiology 1978; 49: 147-148.
12. 12. Van Kooten F, Oedit R, Bakker SL, Dippel DW. Epidural blood patch in post dural puncture headache: a randomised, observer-blind, controlled clinical trial. J Neurol Neurosurg Psychiatry 2008; 79: 553-8.
13. 13. Ylönen P, Kokki H. Epidural blood patch for management of postdural puncture headache in adolescents. Acta Anaesthesiol Scand. 2002 Aug;46(7):794-8.
14. 14. Morewood GH. A rational approach to the cause, prevention and treatment of postdural puncture headache. CMAJ 1993; 149: 1087-93.
15. 15. Vakharia SB, Thomas PS, Rosenbaum AE, Wasenko JJ, Fellows DG. Magnetic resonance imaging of cerebrospinal fluid leak and tamponade effect of blood patch in postdural puncture headache. Anesth Analg 1997; 84: 585-90.
16. 16. Jung IS, Choe H, Han YJ, Son JS. Spontaneous intracranial hypotension treated with epidural blood patch: a case report. Korean J Anesthesiol 2005;49: 581-4.
17. 17. Crawford JS. Experiences with epidural blood patch. Anaesthesia 1980; 35: 513-515.
18. 18. Kang SB, Goodnough DE, Lee YK, Olson RA, Borshoff JA, Furlano MM, Krueger LS. Comparison of 26 and 27 G needles for spinal anesthesia for ambulatory surgery patients. Anesthesiology 1992; 76: 734-38.
19. 19. Lambert DH, Hurley RJ, Hertwig L, Datta S. Role of needle gauge and tip configuration in the production of lumbar puncture headache. Reg Anesth 1997; 22:66-72.
20. 20. Fethi Akyol , Orhan Binici , Ufuk Kuyrukluyildiz , Celaleddin Soyalp , Ilke Kupeli. Why epidural blood patch in postdural pain headache. Medical Science and Discovery 2016; 3(3): 120-3
21. 21. Westbrook JL, Uncles DR, Sitzman BT, Carrie LE. Comparison of the force required for dural puncture with different spinal needles and subsequent leakage of cerebrospinal fluid. Anesth Analg 1994; 79: 769-72.
22. 22. Ready LB, Cuplin S, Haschke RH, Nessly M. Spinal needle determinants of rate of transdural fluid lake. Anaesth Analg 1989; 69: 457-60.
23. 23 Santanen U, Rautoma P, Luurila H. Comparison of 27 gauge Whitacre and Quincke spinal needles with respect to post-dural puncture headache and nondural puncture headache. Acta Anesthesiol Scand 2004; 48: 474-9.