Korean J Anesthesiol.  1979 Dec;12(4):425-428.

Repeated Epidural Blood Patch for Post Lunmbar Puncture Headache

• Kwon OK
• Jeon JK

Abstract

A headache is the most common untoward complication of a spinaI puncture. Many conservative methods of treating post lumbar puncture headaches have been most unsatisfactory. However, use of an epidural blood patch which results in immediate and permanent relief of the headache has been well documented. This case report is that of a 38 year-old pregnant woman who developed a post spinal headache and was treated with repeated epidural blood patches 3 times. The patient had complained of a headache on the 1st postoperative day, then was started on conservative therapy such as fluid infusion, analgesics, etc., but there was no relief for her headache. An attempt at an epidural blood patch for treating headache was decided on the 2nd postoperative day. A lumbar puncture using a Tuohy needle was performed in a sitting position at the L 4-5 interspace, which was one interspace below the site punctured for the spinal anesthesis. Then l0 ml of autologaus blood was injected in the identified epidural space. The patient did well for 15 hours after the 1st attempt, until she started having the same intense headache, so that a 2nd attempt of using a blood patch with another 10 ml of autologous blood was carried out with the same good result. About 15 hours later, she started having a same kind of headache with neck rigidity. The 3rd attempt with a blood patch was considered again and lumbar tapping for the 3rd attempt was performed at the L 3-4 interspace which was the same level of puncture when the spinal anesthesia was performed. This last attempt resulted in permanent and satisfactory relief of headache with no untoward complications. However, possible complications from repeated blood patches should be seriously considered, and an absolute indication must be evaluated to avoid additional complications from the repeated blood patches. Possibilities of additional complications from repeated blood patches are as follows: l. Incidence of localized back pain is increased due to repeated puncture with a large bore needle. 2. Possibility of inadvertent subdural puncture is increased due to reduced epidural negative pressure by the preinjected hematoma formed in the epidural space. 3. Possibility of epidural abscess is increased by the repeated blood injection because blood is a good media for bacterial growth. 4. Chances of nerve root compression are increased due to repeated blood injections into the same area.

MeSH Terms

Analgesics
Anesthesia, Spinal
Back Pain
Blood Patch, Epidural*
Epidural Abscess
Epidural Space
Female
Headache*
Hematoma
Humans
Incidence
Neck
Needles
Pregnant Women
Punctures*
Radiculopathy
Spinal Puncture
Analgesics