Effect Of Epidural Blood Patch Research Articles

Characterizing the Need for Multiple Epidural Blood Patches in the Treatment of Postdural Puncture Headache: An Observational Study

(Reg Anesth Pain Med. 2021;46:1110–1112) Previous studies have determined the effectiveness of epidural blood patch (EBP) on postdural puncture headache (PDPH) patients, though little research has been done on repeated image guided EBP. This study aims to predict the factors contributing to and the rate of repeated image-guided EBP treatment for (PDPH) patients.

Chronic pain in parturients with an accidental dural puncture: A case-controlled prospective observational study.

We set out to examine incidence of chronic headache and back pain in women with PDPH after accidental dural puncture during labor. Chronic headache, backache, and disability were assessed 18-24months postpartum. Women with PDPH treated with epidural blood patch (PDPH-EBP) were identified and matched with women who had a PDPH without epidural blood patch (PDPH-no EBP), with women with uncomplicated epidural analgesia and with women without epidural analgesia. Our primary outcome was incidence of chronic headache and backache. Secondary outcome was the effect of epidural blood patch on chronic pain development. We used Chi-square or Fisher's exact test to calculate odds ratios. There was no statistically significant difference in demographic characteristics between groups. In the no epidural group, no women reported chronic headache and 2/116 (1.7%) reported chronic backache. In the uncomplicated epidural group, no women reported chronic headache and 7/116 (6.0%) reported chronic backache. In the PDPH-no EBP group, 9/56 (16.1%) women reported chronic headache and 10/56 (17.9%) reported chronic backache. In the PDPH-EBP group, 12/59 (20.3%) had chronic headache and 14/59 (23.7%) had chronic backache. No women in the no epidural or uncomplicated epidural group reported disability (chronic pain score of 3 or 4). High disability was reported by 8.9% of women in the PDPH-no EBP group and by 8.4% in the PDPH-EBP group. Women with PDPH had a high incidence of chronic headache, back pain, and disability. We did not find a statistically significant difference in chronic pain development between conservatively treated and EBP-treated patients.

The effectiveness of epidural blood patch in patients with cerebral palsy treated with intrathecal baclofen implantation

Cerebrospinal fluid leak and postdural puncture spinal headache following intrathecal baclofen therapy are known complications. Although primary treatments are conservative, epidural blood patch is an alternative in patients with persistent and severe symptoms. The purpose of this article is to review the effectiveness of epidural blood patch for the treatment of spinal headache and cerebrospinal fluid leak associated with intrathecal baclofen treatment in children with cerebral palsy. Our database was reviewed for epidural blood patch in 341 pediatric patients with cerebral palsy who underwent primary intrathecal baclofen treatment from 2004 to 2018 at one institution. The number of patches, time frame of treatment, and effectiveness of the epidural blood patch were collected. All patients treated with epidural blood patch were evaluated for primary and secondary intrathecal baclofen-related procedures, and subsequent treatment of intrathecal baclofen associated with cerebrospinal fluid leak and spinal headache. Twenty-nine epidural blood patch procedures were performed on 26 patients who had received intrathecal baclofen procedures. Of these 26 patients, four had a secondary epidural blood patch. The incidence of spinal headache/cerebrospinal fluid leak was 31% (107/341), and 81/107 (76%) patients with spinal headache/cerebrospinal fluid leak responded to conservative treatments. Success rate for initial epidural blood patch was 79.3% (23/29). The second epidural blood patch was performed in four patients after failure of initial epidural blood patch. Second epidural blood patch success rate was 75% (3/4). Spinal headache and cerebrospinal fluid leak are known complications after intrathecal baclofen treatment in children with cerebral palsy. When conservative treatments are unsuccessful, epidural blood patch can be used with confidence for these patients. In patients with ongoing symptoms, it is possible to obtain success by repeating the epidural blood patch to continue intrathecal baclofen treatment and avoid aggressive surgery.

Effect of Epidural Autologous Blood Patch on the Prevention of Post-dural Puncture Headche after Spinal Anesthesia

Background: Post-dural puncture headache (PDPH) is one of the well-known complication of spinal anesthesia. Epidural blood patch is the treatment of choice for PDPH but is rarely used for the prevention of PDPH after spinal anesthesia. The purpose of this study is to observe the effectiveness of epidural blood patch for prevention of PDPH and to evaluate the complications after epidural blood injection. Methods: Three hundred patients (ASA I or II) receiving spinal anesthesia were studied. They were randomly devided into two groups. Patients in Group I, the control group, were maintained in a supine position for 24 hour after spinal anesthesia. Patients in Group II, the study group, received 3 ml of autologous blood in the epidural space after spinal anesthesia. PDPH was evaluated for 5 days. The incidence, location, onset, and duration of headache in the patients presenting with PDPH were measured for 5 days, and the complications following epidural blood patch in Group II were observed for 2 weeks. Results: The incidence of PDPH in group I was 11%, but 0% in group II. There were no specific complications following epidural blood patch in Group II. Conclusions: This study suggest that the 3 ml epidural autologous blood patch is an useful method for the prevention of PDPH in patients with spinal anesthesia. (Korean J Anesthesiol 1998; 35: 933∼938)

The effect of epidural blood patch on hearing loss in patients with severe postdural puncture headache

The effect of epidural blood patch on hearing loss in patients with severe postdural puncture headache

The effect of epidural blood patch on hearing loss in patients with severe postdural puncture headache

Study Objective: To determine the immediate effect of epidural blood patch (EBP) on the hearing loss that can accompany postdural puncture headache (PDPH). Design: Prospective open study. Setting: Anesthetic and otolaryngologic departments at a university hospital. Subjects: 16 patients who developed severe PDPH following either myelography or spinal anesthesia. Interventions: Epidural injection of 15 ml of autologous blood. Measurements and Main Results: Audiometry at 250, 500, 1,000, 2,000, 4,000, and 8,000 Hz before and one hour after the epidural blood patch was performed. Hearing was significantly improved in 12 of the 16 patients studied. The improvement was at least 10 dB at two or more consecutive frequencies, or 5 dB at four or more consecutive frequencies. Conclusion: Epidural blood patch improves hearing within one hour in the majority of patients with severe PDPH.

偶発的硬膜穿刺における早期自己血パッチの硬膜穿刺後頭痛に対する予防効果

偶発的硬膜穿刺における早期自己血パッチの硬膜穿刺後頭痛に対する予防効果

In Vitro Study of the Effect of Epidural Blood Patch on Leakage through a Dural Puncture

Pressure resistance of an experimental epidural blood patch was studied in vitro. Pieces of canine lumbar dura were perforated with a 19-gauge needle (n = 12) or a 25-gauge needle (n = 6) and kept between the intercommunicating chambers of a plexiglass apparatus. One chamber (epidural side) was filled with autologous blood and the other chamber (subdural side) was filled with autologous cerebrospinal fluid. Control studies consisted of dural specimens not exposed to blood on the epidural side (19-gauge, n = 8; 25-gauge, n = 4). After 30 min, the dura was removed and placed in saline for inspection. In blood-treated specimens small sheets of coagulated blood were found attached to the epidural side of the dura, and in eight of the twelve of 19-gauge puncture experiments and one of the six of the 25-gauge puncture experiments clotted blood was visible on the subdural side. The dura was then placed back into the chamber for pressure testing 30 min or 16-18 hr later. The subdural chamber was filled with saline and air was left in the epidural chamber. Pressure (1.5, 20, 30, 40, and 50 mm Hg) was applied by injecting additional saline into the subdural chamber. Each pressure level was maintained for 5 min. Saline leaked through the perforation in all control specimens at 1.5 mm Hg pressure. Four blood-treated specimens showed some leakage at 20 mm Hg. All dura specimens perforated with a 19-gauge needle leaked at 40 mm Hg, five of them only at the lowest score rate, 1-4 drops/5 min. One blood-patched dura perforated with a 25-gauge needle did not leak until the pressure reached 50 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)