If a procedure requires a spinal puncture (such as a spinal tap or lumbar epidural) one complication that may arise is a headache. Headache is a result of leaking cerebrospinal fluid (CFS) from the site of injection. Your Chicago pain doctor may recommend an epidural blood patch to correct spinal headache from low fluid pressure in the epidural space.
An epidural blood patch is an outpatient procedure that involves drawing a small amount of blood from the patient, then injecting it into the epidural space. After the blood is administered, it will clot and form a patch sealing the site and preventing CSF from leaking over 95% of the time.
What conditions are treatable with an epidural blood patch?
This minimally invasive procedure is generally used for a post-lumbar puncture headache. The two most common types of surgeries resulting in this are myelograms, spinal anesthesia during surgery, or a diagnostic lumbar spinal tap. Up to 30% of patients will experience post procedural symptoms and need an epidural blood patch or further treatment. A treatment for acute symptoms is bed rest combined with the increased intake of caffeine. This seemed to help within two weeks 80% of the time.
In many cases an acute headache following a spinal tap or epidural will naturally heal with time as the body restores fluid to the epidural space and the pressure stabilizes. In more severe cases of headache, an epidural blood patch can offer relief. Typically if your headache starts 10 to 72 hours after a procedure involving a spinal puncture and the pain increases in severity when you attempt to sit up or when standing, a blood patch may be effective.
How is the epidural blood patch treatment performed?
An epidural blood patch procedure takes on average about 30 minutes. The patient will feel slight pressure and maybe tingling as the doctor withdraws blood and administers it adjacently to the leak of the CSF fluid.
Your doctor will use an MRI or CT scan to confirm a CSF leak or lumbar puncture.
- Site preparation
After carefully cleaning the insertion site, the medical personnel will administer local anesthesia.
- Blood draw
15-20 ml of blood is drawn from a vein or an IV.
- Insertion of the needle
You will need to be very still as a thin needle will be guided to the epidural space close to the CSF leak. Your doctor uses an x-ray to help guide the needle correctly into the area. Any back pain or leg pain should be reported to your doctor. Your blood will be injected into the spine, and as it clots, the leak should be sealed.
You may experience stiffness and soreness in your back for up to 48 hours. In many instances the patient’s headache is immediately relieved. You should not lift heavy items or engage in strenuous exercise. The shower is allowed, but not swimming or a full bath.
If the first epidural blood patch does not work, a second one will usually “do the trick.”
What risk or side effects are there for an epidural blood patch?
Temporarily soreness and stiffness at the site area are the number one side effect reported. The procedure utilizes the patient’s blood so rejection is rare. If fever, drainage from the injection site, or clouded thinking occurs, the patient should contact their doctor immediately. Other side effects may be cramping, feeling dizzy, or tinnitus. Side effects are very low and rare, only about 3% of patients experience symptoms past 72 hours.
How successful are epidural blood patches the relief of headache pain?
Studies have shown that in 95% of severe cases of spinal headache, and epidural blood patch has been effective with just one treatment. When a patient experiences persistent symptoms, a second injection has a 97% success rate. Symptoms seem to be instantaneously removed after the injection.