Why epidural blood patch in postdural pain headache

Year 2016, Volume: 3 Issue: 3, 120 - 123, 15.02.2016

Fethi Akyol Orhan Binici , Ufuk Kuyrukluyildiz , Celaleddin Soyalp , İlke Kupeli

https://doi.org/10.17546/msd.74561

Cited By: 1

Abstract

Objective: Spinal anesthesia has some complications such as intravascular injections, nerve injuries, hypotension, bradycardia and dural ruptures. When puncture is performed on dura or araknoid, there is a risk of post-dural-puncture headache.

Material and Methods: 16003 patients, who were operated at the Erzincan State Hospital and Erzincan Mengücek Gazi Education and Research Hospital between 2004 and 2011 were involved in this study. Epidural blood patch was applied on 159 patients complaining of post-dural-puncture headaches. 15 ml of the autologous blood was given to the epidural region in the surgery room for patients which had epidural blood patch applied. Epidural blood patch was applied 2 days after the dural injury

Results: 72 females and 67 males were involved in the study. Symptoms of post-dural-puncture headache disappeared within minutes immediately after the process.  After the first application of epidural blood patch, 156 patients felt relaxed. 3 patients had a relief after the first application, but their symptoms relapsed, and a second injection was performed 24 hours after the first one.  Following the second epidural blood patch,    none of the patients reported any headaches.  No complications emerged during the procedure in the patients. The patients were discharged 2-3 hours after the epidural blood patch application.

Discussion: Epidural blood patch is a treatment method with lower risks of complications, lower costs and high success rate for post-dural-puncture headache patients. It is advised especially after the C-section, for preserving mother-baby communication.

Keywords

Blood Patch; Epidural; Postdural; Pain; headache; Anesthesia, Spinal

References

• Cicek T, Gonulalan U, Dogan R, Kosan M, Istanbulluoglu O, Gonen M, Ozturk B, Ozkardes H. Spinal anesthesia is an efficient and safe anesthetic method for percutaneous nephrolithotomy. Urology. 2014;83:50-5.
• Liu SS, Strodtbeck WM, Richman JM, Wu CL. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg. 2005;101:1634-42.
• Dadure C, Macq C, Sola C, Raux O.Regional anesthesia for postoperative analgesia at home in children. Ann Fr Anesth Reanim. 2013 ;32:17-20
• J. B. Whiteside,J. A. W. Wildsmith. Developments in local anaesthetic drugs. Br J Anaesth 2001; 87: 27–35
• Morgan GE, Mikhail MS, Murray MJ, Larson CP. Regional Anesthesia&Pain Management In: Morgan GE (Ed).Clinical Anesthesiology. 3rd ed. Los Angeles: The McGraw-Hill Companies; 2002. p.253-344.
• Jadon A, Chakraborty S, Sinha N, Agrawal R. Intrathecal Catheterization by Epidural Catheter: Management of Accidental Dural Puncture and Prophylaxis of PDPH Indian J Anaesth 2009;53: 30-4.
• Agarwal A, Kishore K. Complications and controversies of regional anaesthesia: a review. India J Anaesth 2009; 53: 543-53.
• Vallejo MC, Mandell GL, Sabo DP, Ramanathan S. Postdural puncture headache: a randomized comparison of five spinal needles in obstetric patients. Anesth Analg 91: 916-20,2000.
• 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.
• Vandam LD, Dripps RD. Long-term follow-up of patients who received 10 098 spinal anesthetics. JAMA 1954; 156:1486-1491.
• Horlocker TT, McGregor DG, Matsushige DK, Schroeder DR, Besse JA A retrospective review of 4767 consecutive spinal anesthetics: central nervous system complications. Perioperative Outcomes Group. Anesth Analg. 1997;84:578-84.
• Liu SS, McDonald SB. Current issues in spinal anesthesia. Anesthesiology. 2001;94:888-906
• Kang SB, Goodnough DE, Lee YK, Olson RA, Borshoff JA, Furlano MM, et al. Comparison of 26 and 27 G needles for spinal anesthesia for ambulatory surgery patients. Anesthesiology 1992;76:734-38.
• Pearce JM.Walter Essex Wynter, Quincke, and lumbar puncture. J Neurol Neurosurg Psychiatry 1994; 57: 179.
• 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.
• Reina MA, de Leon-Casasola OA, Lopez A, De Andres J, Martin S, Mora M. An in vitro study of dural lesions produced by 25-gauge Quincke and Whitacre needles evaluated by scanning electron microscopy. Reg Anesth Pain Med 2000;25(4):393-402.
• 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.
• Ready LB, Cuplin S, Haschke RH, Nessly M. Spinal needle determinants of rate of transdural fluid lake. Anaesth Analg 1989;69:457-60. 59
• Üniver S, Özgök A, Ebil S. 24 G Sprotte ve 26 G Atracuan spinal iğnelerin elektron mikroskopik ve postdural ponksiyon baş ağrısı yönünden karşılaştırılması. Anestezi Dergisi 1998;6:83-6.
• Barker P. Headache after dural puncture. Anesthesia 1989;44:696-7.
• Flaatten H, Rodt SA, Vamnes J, Rosland J, Wisborg T, Koller ME. Postdural puncture headache. A comparison between 26- and 29- gauge needles in young patients. Anaesthesia 1989; 44: 147-9.
• Jeanjean P, Montpellier D, Carnec J, Crasquin O, Koral E, Line B, et al. Headaches after spinal anesthesia: prospective multicenter study of a young adult population. France Ann Fr Anesth Reanim 1997;16(4):350-3.
• Despond O, Meuret P, Hemmings G. Postdural puncture headache after spinal anaesthesia in young orthopaedic outpatients using 27-g needles. Canadian J Anaesth 1998 Nov; 45(11):1106-9.
• Frenkel C, Altscher T, Groben V, Hörnchen U. The incidence of post spinal headache in a group of young patients. German Anaesthesist 1992; 41(3):142-5.
• Szeinfeld M, Ihmeidan IH, Moser MM, Machado R, Klose KJ, Serafini AN. Epidural blood patch: evaluation of the volume and spread of blood injected into the epidural space. Anesthesiology. 1986;64:820-2.
• Marr R, Kapoor A, Redfern N. Epidural blood patch is the gold standard treatment for dural puncture headache. Br J Anaesth. 2012 Aug;109(2):288-9; author reply 289. doi: 10.1093/bja/aes240.
• Keemer F. Breastfeeding self-efficacy of women using second-line strategies for healthy term infants in the first week postpartum: an Australian observational study.Int Breastfeed J. 2013;8:18.