During an epidural blood patch (EBP), a small volume of autologous blood is injected into a patient’s epidural space to stop a leak of cerebrospinal fluid (CSF). A CSF leak may lead to a post-dural puncture headache (PDPH), also known as a spinal headache.
Cerebrospinal fluid is a clear, colorless fluid found in the brain and spinal cord. CSF helps protect the central nervous system by acting like a cushion against sudden impact or injury to the brain or spinal cord.
Symptoms of Spinal Headache
Signs of a spinal headache include:
- Dull, throbbing pain that varies in intensity from mild to debilitating
- Pain that worsens when sitting up or standing and decreases or goes away when lying down
Spinal headaches are often accompanied by the following symptoms:
- Dizziness
- Ringing in the ears (tinnitus)
- Hearing loss
- Blurred or double vision
- Sensitivity to light (photophobia)
- Nausea and vomiting
- Neck pain or stiffness
- Seizures
Causes of Spinal Headaches
Spinal headaches are caused by a leak of cerebrospinal fluid through a puncture hole in the tough membrane that surrounds the spinal cord.
A spinal headache typically appears within 48 hours after a spinal tap or spinal anesthesia.
Another potential cause of spinal headaches is epidural anesthesia. During the procedure, the membrane may be unintentionally punctured and lead to a spinal headache.
Risk Factors
Individuals at greater risk of developing a spinal headache:
- Are between the ages of 18 and 30
- Are female
- Are pregnant
- Have a history of chronic headaches
- Have undergone procedures involving the use of larger needles or multiple punctures in the membrane that surrounds the spinal cord
- Have a small body mass
Before The Procedure
Before patients can receive an epidural blood patch, they will be asked to describe their current symptoms, past medical history, and medications they are currently taking. Patients will receive detailed instructions on how to prepare and the nurse will explain in detail what happens during an epidural blood patch procedure.
What to Expect During an Epidural Blood Patch
The patient will be seated during the procedure. Some patients won’t be able to tolerate this seated position for more than a few minutes, if at all, because sitting exacerbates symptoms. The physician will begin by cleaning the injection site and prepare the extremity from which the blood will be drawn.
Under ultrasound or X-ray guidance, the physician will place the needle into the epidural space and inject a small amount of contrast dye to ensure proper needle placement. The physician will then slowly inject the blood to create a blood patch. The injection might cause discomfort and some cramping.
After the procedure, the patient will need to lay flat for about an hour before they can be discharged.
Potential Side Effects And Risks
The risks of an epidural blood patch include:
- Failure (in 15 to 20% of cases)
- Worsening of post-dural puncture headache (PDPH)
- Creation of additional dural rent(s)
- Temporary mild to moderate back pain
- Infection
Patients should speak to their doctor to find out if they are a good candidate for an epidural blood patch.
