Korean J Pain.  2022 Apr;35(2):224-230. 10.3344/kjp.2022.35.2.224.

Risk factors associated with repeated epidural blood patches using autologous blood

• Oh AR
• Park J
• Jeong JS
• Lee JY
• Choi JW
• Kim H
• Sim WS

• KMID: 2527773
• DOI: http://doi.org/10.3344/kjp.2022.35.2.224

Abstract

Background
An epidural blood patch (EBP) is a procedure to treat intracranial hypotension that does not respond to conservative treatment. EBPs are commonly repeated when the symptoms persist. In this study, we used a large single-center retrospective cohort and evaluated the factors associated with repeated EBPs.
Methods
From January 2010 to December 2020, a total of 596 patients were treated with EBPs for intracranial hypotension. We evaluated the factors associated with repeated EBPs in the entire population, in patients with spontaneous intracranial hypotension (SIH), and in those with available myelographies.
Results
In a total of 596 patients, 125 (21.1%) patients required repeated EBPs, and 96/278 (34.5%) in SIH and 29/314 (9.2%) in iatrogenic population. In patients with SIH, international normalized ratio (INR) and cerebrospinal fluid (CSF) leakage on myelographies consistently exhibited significant associations (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.02–1.87; P = 0.043 and OR, 2.18; 95% CI, 1.28–3.69; P = 0.004). In patients with iatrogenic injury, INR and CSF leakage on myelogram did not show difference in repeated EBPs.
Conclusions
Repeated EBPs may be more frequently required in patients with SIH. Prolonged INR and CSF leakage were associated with repeated EBPs in patient with SIH. Further studies are needed to determine factors associated with repeated EBP requirements.

Keyword

Blood Patch; Epidural; Cerebrospinal Fluid Leak; Headache; Intracranial Hypotension; Pain Management; Patient Outcome Assessment; Post-Dural Puncture Headache; Therapeutics

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