Epidural Blood Patch

An epidural blood patch is an injection of blood into the epidural space. The spinal cord, which along with the spinal nerves, is in a sack that contains cerebrospinal fluid.

The outer region of this sack is called the epidural space. This procedure is required when there is leakage of cerebrospinal fluid into the epidural pain-procedure1space.

Why is the epidural blood patch done?

Several procedures require injections into the spinal column, such as an epidural during labor, a therapeutic spinal injection, a diagnostic spinal tap, and an epidural steroid injection. A few patients have a severe headache after these procedures, which is often worse with standing and improves with lying down.

The headache occurs as a result of persistent leakage of the cerebrospinal fluid into the epidural space. While the headache is harmless, it can be debilitating, interfering with normal activities. The epidural blood patch involves drawling fresh blood from the patient and using it to plug the leak.

How long does it take to do an epidural blood patch?

The entire procedure will take about 30-60 minutes. While the actual injection only takes around 2 minutes, the medical staff will have to give you instructions and have you sign a consent form before the procedure. Also, following the procedure, a nurse will monitor you for approximately 20 minutes in the recovery room.

Are there any medications used?

The doctor will apply or inject a local anesthetic to numb the skin. In addition, you may be given an oral sedative or receive this medication through an intravenous (IV) line.

Does the epidural blood patch hurt?

Because the doctor uses topical and/or an injection of local anesthetic, you may feel a slight pinch followed by a burning sensation that lasts for a short amount of time. The anesthetic is instilled with a very small needle, so pain is minimal. Once the skin is numb, the procedure itself will produce a pressure sensation at the injection site.

Will I be put to sleep for the procedure?

Most pain specialists do the epidural blood patch procedure using local anesthesia and mild sedation. However, you can have IV sedation if you request it. The sedation often causes you to have little or no memory of the procedure, but this depends on the type of sedation and the medication given.

It is important for you not to eat or drink anything six hours before the sedation. In addition, you must bring someone to take you home, as you cannot drive after the procedure.

How is the epidural blood patch done?

The doctor will have you lie on your stomach. During the procedure, your blood pressure, heart rate, and oxygen levels are monitored. The nurse places a small intravenous catheter into your arm. The skin on the back is cleaned with an antiseptic solution, which will feel cool.

The anesthetic agent is injected, and then the doctor places the epidural needle near the affected area. The doctor draws 25 cc of blood from your vein and slowly injects the blood into the epidural space.

How will I feel after the procedure?

Immediately after the epidural blood patch, you will feel a pressure sensation in the back. This is related to the effect of the blood in the epidural space. In addition, most patients enjoy immediate relief of pain once the space is patched.

You will rest in recovery for approximately 30 minutes. You will not allowed to return to work until the next day, as you should rest the remainder of the day. The recovery room nurse will advise you of what activities are permitted.

What are the risks and side effects of the epidural blood patch?

The procedure has few risks and side effects, but these include increased pain at the injection site, continued headache, bleeding, infection, and nerve damage.

Does the epidural blood patch work?

Several observational research studies show success rates of the epidural blood patch for between 70 and 90%. The effectiveness of prophylactic treatment has not yet been established, however.

 

Resources

Taivanen T, Pitkanen M, Tuominen M, Rosenberg P. Efficacy of the epidural blood patch for postdural puncture headache. Acta Anaesthesiol Scand. 1993;37:702–705.

Williams E, Beaulieu P, Fawcett W, Jenkins J. Efficacy of epidural blood patch in the obstetric population. International Journal of Obstetric Anaesthesia. 1999;8:105–109. doi: 10.1016/S0959-289X(99)80007-7.