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    Epidural Blood Patch

    Overview
    Preparing for the Procedure
    During the Procedure
    After the Procedure
    Risk Factors
    Contributed by:
    SingHealth Duke-NUS Anaesthesiology & Perioperative Sciences Academic Clinical Programme

    Overview


    Epidural Blood Patch: What is it?

    Some people who have been administered a spinal or epidural injection may develop a headache as a side effect. This is because of leakage of cerebrospinal fluid (CSF) from a small hole in the dura, produced during the spinal or epidural injection. The dura covers the brain and spinal cord, and contains this fluid. Initial treatment includes painkillers and simple measures like rest and hydration, but if these do not help then an epidural blood patch may be offered as treatment.

    An epidural blood patch is a procedure done to seal the hole in the dura and stop further CSF leak. This helps relieve the headache in most patients soon after.

    It requires the insertion of an epidural needle in the back, similar to how it is performed for relief of pain during labour, but instead of medication, some of the patient’s own blood, drawn at the same time, is injected into the needle, forming a blood clot around the hole, thereby sealing it and relieving the headache.

    Preparing for the Procedure

    The Anaesthetist will first discuss this procedure with the patient in detail, advising the advantages and side effects and will also answer any questions that the patient may have.

    If the patient agrees, the patient will be asked to sign a form consenting to this treatment. The Anaesthetist will advise of any precautions that the patient may need to take specifically.

    On the day of the procedure, the patient can eat and drink as normal. If the patient is breastfeeding her baby, the patient may continue to do so till just prior to the procedure.

    Painkillers and regular medications prescribed to the patient by their doctor can also be continued. However, the patient must remind the doctor about any medications that may affect blood clotting, including traditional chinese medicine, as these need to be stopped temporarily prior to this procedure.

    During the Procedure

    This will be done in the operation room suite. The patient will lie on their side for the procedure and will not need sedation or general anaesthesia. After the back is cleaned with a disinfectant, some local anaesthetic will be injected there to numb the skin. This is followed by another injection to locate the epidural space. At the same time, a little bit of the patient’s own blood will also be drawn from their arm and injected through the epidural needle. Some patients may complain of pressure or discomfort in the back or neck during or after the blood patch procedure. The patient should inform the doctor immediately of any pressure or discomfort.

    The entire process should take about 30-40 minutes. It is not very painful and provides good relief in most cases.

    After the Procedure

    The patient will be asked to rest on their back, in bed, for at least 2 hours, after which they will be allowed to gently stand up and walk with some support. If symptoms are relieved, the doctor may discharge the patient home the same day.

    In 60 to 70% of patients, the epidural blood patch will cure the headache within a few minutes to a few hours. If the headache persists after 24 to 48 hours of the procedure, inform the doctor. Rarely, a second blood patch may be required.

    At home, it is very important to avoid lifting any heavy objects for at least 2 days after the procedure as this may dislodge the clot and the headache may return.

    Risk Factors

    Side effects such as bruising and pain over the injection site are common and temporary(< 3 to 4 days). There is a small chance (< 1%) that a second Dural hole may be created, similar to the first one. Infection, bleeding and nerve damage are serious but rare risks, occurring in< 0.1% of cases. Should the patient develop any numbness or weakness in the leg(s) or have difficulty in passing urine or going to the toilet after the procedure, contact the hospital urgently. Similarly, any new onset fever or a back pain requires that the patient should seek help urgently.

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