FAQs on Epidural Blood Patch
The epidural blood patch procedure is done following a spinal procedure when the patient has a headache related to cerebral spinal fluid leakage. The spinal headache can occur up to five days after certain procedures. There are many conditions where patients must have injections into the spinal columns. These include a diagnostic spinal tap, an epidural used during labor, a therapeutic spinal injection, and a lumbar puncture. Some patients experience a severe headache after the spinal procedure, and this headache will get worse with standing and better with lying down. The pain is related to a persistent slow lead of spinal fluid into the epidural space. The headache is harmful, but it can be quite debilitating. The treatment for this is an epidural blood patch.
Conservative management of a spinal headache involves adequate hydration to increase cerebral spinal fluid pressure. This is often accomplished with adequate intravenous hydration or by having the patient drink fluids with caffeine, such as soft drinks. The caffeine will increase cerebral spinal fluid pressure. Also, bed rest for 24 to 48 hours will help.
The epidural blood patch procedure is used when conservative measures fail. It is done by inserting a needle into the same space that the lumbar puncture was done or right next to this space. Blood from the patient is injected into this space to “patch” the leak. Relief of the headache is said to be immediate or shortly after the blood patch has congealed. Rarely, however, the epidural blood patch does not work for the patient, and a second patch is necessary. Success rates are 90% for the first patch, and 95% for the second one.
For the treatment of persistent headache and/or nausea that often follows a spinal puncture, the epidural blood patch procedure consists of a single injection of autologous blood. When the blood is introduced, it patches the hole in the outer membrane of the spinal cord, called the dura. This hole was initially created by the needle during the myelography.
The epidural blood patch procedure is usually done with the patient lying on his/her stomach. The blood pressure, heart rate, and oxygen levels are monitored during the procedure, and an x-ray technician and nurse will be in the room with the doctor. The skin at the injection site is cleansed with an antiseptic solution, and an IV catheter is placed in the vein. At a separate vein, the doctor draws 25 cc of blood to use to patch the area.
After the Procedure
After the blood patch procedure, you can expect to feel pressure at the injection site. This is where the blood is in the epidural space. Once you have rested for 30 minutes, the recovery room nurse will ask you to stand up. You should have immediate relief from the headache, and after a few hours, your body will be given the chance to replenish the lost spinal fluid. The headache will continue to get better after the procedure.
The doctor will advise you to take it easy a day or so after the epidural blood patch procedure. You should rest for the first day, but going to the bathroom is permitted. The surgical staff will discuss home care with you before you leave the medical center. You will not be able to return to work and usual activities for a couple of days.
Frequently Asked Questions
How long does an epidural blood patch take? The epidural blood patch takes a few minutes to perform. You should allow an hour and a half for this procedure, and this includes the time it takes for you to sign the consent form, be positioned, the doctor to perform the procedure, and for observation in the recovery area. A nurse stays with you for a short period of time to make sure you have no problems after this procedure.
Does the epidural blood patch hurt? The patch s done by injecting a small amount of local anesthetic through a small needle. You should expect to feel a little pinch sensation and slight burning. Once the skin is numbed, there procedure needle causes pressure at the site of injection. Many patients are given an oral sedative before the procedure to help.
Will I be put to sleep during the procedure? Not usually, but the choice is yours. Ask the doctor which option is best for you. You can have oral or IV sedation, which makes you comfortable. Be sure not to eat or drink anything six hours before the procedure, have a driver to take you home if you do receive sedation or anesthesia, and consult about after care with the doctor.
Madsen SA, Fomsgaard JS, & Jensen R (2011). Epidural blood patch for refractory low CSF pressure headache: a pilot study. Journal of Headache Pain, 12(4), 453-457.