An epidural blood patch is an injection of blood into the epidural space, which is outside the spinal cord and between the epidural layer of tissue. The spinal cord and spinal nerves are surrounding by sack of cerebrospinal fluid (CSF), which cushions and supports these structures. Outside the sack is the epidural space.

Why is an epidural blood patch done?

Certain medical conditions require that patients have injections in the spinal column, such as a diagnostic spinal tap, an epidural during labor, or a therapeutic spinal injection. A side effect to these procedures is severe headache, which is called a post-dural puncture headache (PDPH).

This headache usually worsens with standing, and it occurs in around 30% of patients who undergo lumbar puncture. PDPH is the result of a decrease in CSF volume and pressure. While the headache can be severe, the spinal fluid leakage is harmless. To alleviate the pain, the doctor will inject a freshly drawn sample of the patient’s own blood, which plugs the leak and relieves the headache.

What symptoms are associated with PDPH?

Besides having a severe headache, the patient often experiences double vision, ringing of the ears, muscle aches, and dizziness. Most PDPHs occur within 48 hours of the spinal procedure. In the majority of patients, PDPH and associated symptoms are self-limiting, but for 20% of cases, the symptoms continue for weeks to months.

How long does an epidural blood patch take?

The actual injection of blood only takes a few minutes. However, you should allow around an hour and a half for the total process. The epidural blood patch procedure involves discussing side effects and complications with the doctor before the injection, signing a consent form, and pre-procedure monitoring.

What should I expect before the procedure?

Before the epidural patch procedure, you need to discuss the medications you are taking with the doctor. In addition, ask the doctor which medicines to hold and which drugs to take before the procedure. You are not allowed to eat or drink for around 6 hours prior to the epidural blood patch, and should bring someone with you to drive you home.

Does the epidural blood patch injection hurt?

The doctor will numb the skin and soft tissues with a local anesthetic given through a tiny needle. This will feel like a slight pinch and burning, as the medicine is injected. Once the skin is numb, you only feel a slight bit of pressure at the epidural injection site. The doctor will offer you sedation by mouth or IV before the procedure, if you wish to have this.

What happens during the epidural blood patch procedure?

You will be taken to the procedure room, and a nurse will insert an IV catheter into your arm to draw blood and deliver medications. The back is cleansed with an antiseptic solution, and the doctor numbs the skin with an anesthetic agent. Using fluoroscopy (x-ray guidance), the doctor inserts a small needle into the area where the CSF is leaking. The blood drawn from your arm is injected into the leak, and as it clots, the leak seals.

What to expect after the procedure?

After the procedure, you are taken to a recovery room, where a nurse monitors your condition for approximately 30-45 minutes. You must lie on your back and remain still for at least 30 minutes, while the nurse monitors your vital signs. Once stable, you are allowed to go home. However, you must continue bed rest for 24 hours, and should avoid any sudden movement or strenuous activity for 2-3 days post-procedure.

What are the risks and complications associated with the epidural blood patch?

As with any minimally invasive procedure, there are some risks and complications associated with an epidural blood patch. However, these adverse events are rare. They include reaction to anesthesia, sedative medication or contrast dye, as well as dizziness, infection, and bleeding.

How effective is the epidural blood patch?

Many observational studies have showed high efficacy rates with the epidural blood patch. The success rate is around 80-90%, with most patients reporting complete headache pain relief soon after the procedure.

Resources

Oedit, R, van Kooten, F, Bakker, SLM, & Dippel, DWJ (2005). Efficacy of the epidural blood patch for the treatment of post lumbar puncture headache BLOPP: A randomised, observer-blind, controlled clinical trial. BMC Neurology, 5(12).

Safa-Tisseront V, Thormann F, Malassine P, Henry M, et al. (2001). Effectiveness of epidural blood patch in the management of post-dural puncture headache. Anaesthesiology, 95:334–339. doi: 10.1097/00000542-200108000-00012.