Effectiveness of epidural blood patch in the management of postdural puncture headache

Epidural blood patch ebp is a gold standard treatment of post dural puncture headache pdph. Effectiveness of epidural blood patch in the management of postdural puncture headache you will receive an email whenever this article is corrected, updated, or cited in the literature. Epidural blood patch for the management of postdural puncture headache abdulkadir atim 1, atilla ergin 2, omer yanarates, murat kuyumcu 3, ercan kurt 2 1 beytepe military hospital, department of anesthesiology, ankara. Health, general activities of daily living headache care and treatment software patches. In obstetric patients, conservative and pharmacological management of postdural puncture headache pdph is often ineffective. His paper discussed the pathophysiology of lowpressure headache resulting from leakage of cerebrospinal fluid csf from the subarachnoid to the epidural space. Meningeal postdural puncture headache, unintentional dural puncture, and the epidural blood patch. The primary end point was any headache at 24 h after the start of treatment.

Postdural puncture headache pdph is frequently associated with neck, vestibular, cochlear, and ocular symptoms. Epidural blood patch for the management of postdural. Epidural blood patch for postdural puncture headache due. Effectiveness of epidural blood patch on postdural puncture. Role of needle gauge and tip configuration in the production of lumbar puncture headache. Epidural blood patches are effective for postdural puncture. Epidural blood patch technique, recovery, and success rate. To determine the efficacy of epidural blood patch edbp for the treatment of post dural puncture headache pdph. A spinal headache is the name for a type of headache that follows a procedure like a spinal tap lumbar puncture or epidural block such as that performed during labor and delivery what causes. If conservative treatment is not sufficient within a few days and the symptoms are severe, an epidural blood patch ebp may be performed. Last, the evidence behind interventional pain modalities and acupuncture will be examined. The epidural blood patch ebp is regarded by many as the goldstandard treatment of postdural puncture headache pdph. Twentyeight patients were randomized to receive ebp or intravenous cosyntropin after diagnosis with postdural puncture headache.

The noninvasive block relieves the disabling headache faster than an epidural blood patch ebp, without the trauma of another epidural procedure, according to results from a retrospective analysis. Ema effectiveness of epidural blood patch in the management. Treatment is the same, with the only highly effective treatment after failed conservative management being epidural blood patch. Post dural punction headache pdph occurs in 10% to 40% of the patients who had a lumbar puncture. Despite a high success rate at the 1st attempt with a blood patch of up to 85 %, some cases require repeating blood patching. Describe how you would perform an epidural blood patch. An epidural blood patch ebp remains the standard against which all other treatments for a pdph are compared. We believe this is the first ever 17year retrospective chart. Keywords postdural puncture headache, epidural blood patch, complication from epidural placement, management of dural puncture 1. Pathophysiology and management of postdural puncture headache. In one study, the success rate of epb in a heterogeneous population that included parturients was 75%. Aug 11, 2010 postdural puncture headache pdph has been a problem for patients, following dural puncture, since august bier reported the first case in 1898.

Post dural puncture headache pdph, also known as post lumbar puncture lp headache, is a common complication of diagnostic lp. Introduction postdural puncture headache classically presents as a postural headache that occurs after puncture of the dura. The headache is severe and described as searing and spreading like hot metal, involving the back and front of the head, and spreading to the neck and shoulders, sometimes involving neck stiffness. Epidural blood patch for treatment of postdural puncture headache in a patient with spinal fusion and recent implantation of intrathecal pain pump. Timing of epidural blood patch wiley online library. Effectiveness of epidural blood patch in th e management of postdural puncture headache. Bier experienced and wrote about the first reported postdural puncture headache. The incidence of inadvertent dural tap at attempted epidural placement in obstetric patients has been reported to be on the order of 0. Effectiveness of lateral decubitus position for preventing postdural puncture. In the case of a cervical or dorsal blood patch, ct guidance is recommended, which ensures epidural application of the blood patch and minimizes the risk of damaging the spinal cord. Epidural blood patching ebp remains the gold standard treatment of pdph. Epidural blood patch is an effective procedure in severe pdph. Clinical report by pakistan armed forces medical journal. Epidural blood patch for management of postdural puncture.

Effectiveness of epidural blood patch on postdural puncture headache. Efficacy of a prophylactic epidural blood patch in preventing post dural puncture headache in parturients after inadvertent dural puncture. The criterionstandard treatment for pdph has been epidural blood patch ebp, but it is an invasive intervention with the potential for severe complications, such as meningitis and paralysis. Efficacy of a prophylactic epidural blood patch in preventing postdural puncture headache in parturients after inadvertent dural puncture. Postduralpuncture headache pdph is a complication of puncture of the dura mater one of the membranes that surround the brain and spinal cord. Sphenopalatine ganglion block effective and safe for. It limits patients general activity and increases the length of hospital stays and the use of care.

Topical sphenopalatine ganglion block compared with epidural. We randomised 42 patients who presented with pdph, lasting 24 h to 1 week, to receive edbp n 19 or conservative treatment n 23. Postdural puncture headache pdph is a complication of puncture of the dura mater one of the membranes that surround the brain and spinal cord. Epidural blood patch for management of postdural puncture headache in. A volume of 12 to 18 ml of autologous blood is injected slowly into the epidural space at the. Effectiveness of epidural blood patch in the management of postdural puncture headache 1. The epidural blood patch is widely accepted as the treatment of choice for postdural puncture headache.

Intravenous tissuetype plasminogen activator therapy for ischemic stroke. Guidelines for the diagnosis, treatment and prevention of. When should an epidural blood patch be performed in postlumbar puncture headache. Intravenous cosyntropin versus epidural blood patch for. Epidural blood patch for postdural puncture headache due to. Standardizing management of postdural puncture headache in.

This technique is known as epidural blood patch and is highly successful in the treatment of postdural puncture headache. It also can occur following spinal anesthesia or, more commonly, inadvertent dural puncture during attempted epidural catheter placement. Prevention of post dural puncture headache with epidural administered dextran 40 letter reg anesth 1992, 17. The incidence of pdph following spinal anaesthesia is epidural blood patch ebp is a common treatment of postdural puncture headache, but its effectiveness and mode of action remain a matter of debate. Uncontrolled studies report rapid recovery after patching in 90% to 100% of treated patients. Blood patching should normally be performed only after the first 24 h, as prior to this it is associated with lower success rates. Epidural patching medical clinical policy bulletins aetna. Effectiveness of epidural blood patch in the management of post. Effects of the serotonin receptor agonist sumatriptan on postdural puncture headache.

Pdph management, epidural blood patch ebp management, and patient followup. Epidural blood patch for the management of postdural puncture. Cosyntropin for prophylaxis against postdural puncture. Epidural blood patch is the standard treatment for pdph. Epidural blood patch is an effective treatment of severe postdural puncture headache. Epidural blood patch in the treatment of post dural puncture. Guidelines for placement of epidural blood patch epidural blood patch is used to manage a persistent, incapacitating dural puncture headache. Postdural puncture headache pdph is one of the most common complications of neuraxial anaesthesia. It is particularly disabling during the postpartum period, when mothers have to take care of their child. Post dural puncture headache pdph, also known as post lumbar puncture lp. Its effectiveness is decreased if dura mater puncture is. Prophylactic epidural blood patch after unintentional dural puncture for the prevention of postdural puncture headache in parturients. Postdural puncture headache in the parturient sciencedirect. Postdural puncture headache pdph has been a problem for patients, following dural puncture, since august bier reported the first case in 1898.

You can manage this and all other alerts in my account. Postdural puncture headache and epidural blood patch. Epidural blood patches are effective for postdural. When deciding to move from conservative therapies to epidural blood patch, be sure to consider that blood patch may require an additional general anesthetic in a child and this is not without risks. Postdural puncture headache pdph is a relatively common complication after lumbar punctures lp. Review of the alternatives to epidural blood patch for treat. Individual state driving restrictions for people with epilepsy in the u. Effectiveness of epidural blood patch in the management of postdural puncture headache. Various treatment modalities have been tried for postdural puncture headache pdph among which epidural blood patch ebp remains as the gold standard. However ebp has its own limitations and complicationsthe procedure is involved and requires collection of blood from the patient and injection of the blood into the epidural space. Postdural puncture headache pdph is the most frequent complication of central neuraxial blockade.

It is a debilitating condition, especially in the parturient, but prompt diagnosis and management can treat it and prevent rare but serious sequelae. Conventional treatment or epidural blood patch for the treatment of different etiologies of post dural puncture headache. For women who suffer from postdural puncture headache, there is a fast and easy solutionsphenopalatine ganglion block spgb. The incidence of pdph following spinal anaesthesia is puncture 2. Epidural blood patch the high success rate 6890% after. This will include a discussion of the various oral or intravenous therapies and the nonbloodcontaining epidural injections. Epidural blood patch in post dural puncture headache. Epidural blood patch ebp is considered the definitive treatment of pdph with a reported success rate of 85%. Efficacy of the epidural blood patch for the treatment of post lumbar. When deciding to move from conservative therapies to epidural blood patch, be sure to consider that blood patch may require an additional general anesthetic in a child and this is. Europe pmc is an archive of life sciences journal literature. Effectiveness of epidural blood patch in the management of. It is thought to result from leakage of cerebrospinal fluid through the dura mater puncture hole and consecutively reduced fluid levels in the brain and spinal cord.

Theophylline for postdural puncture headache abstract. His paper discussed the pathophysiology of lowpressure headache resulting from leakage of cerebrospinal fluid csf from the subarachnoid to. Epidural blood patching for preventing and treating postdural puncture headache. The mainstay of treatment of postdural puncture headache is the administration of autologous blood into the epidural space. However, a randomized trial that included 18 patients did not find any efficacy of tetracosactide in the treatment of pdph, nor in the reduction of blood patch use 45. Effectiveness of epidural blood patch on postdural. Inadvertent dural puncturewet tap and pdph management. Abstract background lumbar epidural blood patch ebp is a common treatment of postdural puncture headache, but its effectiveness and mode of action remain a matter of debate.

Efficacy of the epidural blood patch for the treatment of. The influence of timing on the effectiveness of epidural blood patches in parturients. Epidural blood patch an overview sciencedirect topics. Safatisseront v, thormann f, malassine p, henry m, riou b, coriat p, seebacher j. Pdph is a relatively frequent complication of dural puncture with an estimated incidence of 2 3% after spinal anesthesia, but as high as 70% after inadvertent dural puncture during an epidural anesthetic. Controversy still exists over when to perform an ebp, how much blood to inject, and how to manage patients postebp. Postdural puncture headache pdph postdural puncture headache pdph is a complication of puncture of the dura mater, performed for diagnostic or therapeutic purposes or accidentally, as a complication of epidural anesthesia. Background and objectives postdural puncture headache pdph is a severe and debilitating complication of unintentional dural puncture. The aim of this study was to assess both the effectiveness and the predictive factors of failure of ebp on severe postdural puncture headache. Systemic infection and fever, infection on the back. Postulated reasons for headache following dural tap include. Epidural blood patch cures postdural puncture headache in 90% of cases d. This study evaluated the efficacy of iv cosyntropin as an alternative to epidural blood patch ebp for refractory or severe postdural puncture headache pdph.

1089 1487 692 1285 1501 951 1523 105 315 1221 1313 252 423 242 508 159 1438 503 575 349 1531 1538 277 479 567 21 348 284 170 186 500 1173 886 468 108 1257 190 1458 1255 983 1339 1481