FAQs on Epidural Blood Patch in Colorado

 

An epidural blood patch is used to ease the pain associated with a leak of cerebrospinal fluid from the epidural space around the spinal cord. This involves injected blood into the epidural space.

What is the epidural space?

The epidural space surrounds the dura, which is the “sack” that houses the spinal cord. This sack contains the clear cerebrospinal fluid, which surrounds the spinal cord and spinal nerves.

Why is an epidural blood patch done?

There are certain medical conditions that are treated with an epidural steroid injection. This injection involves instilling a steroidal agent into the epidural space. In addition, some patients require a diagnostic “spinal tap,” which is used to test the cerebrospinal fluid for infection. Another procedure that punctures the epidural area is an anesthetic used during labor.

For a small percentage of people who have a therapeutic epidural steroid injection, epidural, or spinal tap, a persistent leak of fluid occurs. As the fluid seeps into the epidural space, it can cause a headache, which is harmless but causes distress. The epidural blood patch is a means of stopping the fluid leak.

How long does the procedure take?

The actual epidural blood patch injection takes only a few minutes. However, you should allow 60-90 minutes for the procedure, which includes filling out paperwork, signing a consent form, starting your IV catheter line, positioning in the room, and observation in the recovery area afterwards.

Will the epidural blood patch hurt?

A local anesthetic is used to numb the skin and deeper tissues. Also, a sedative may be used to make you more comfortable. You can expect to feel a slight pinch and some burning as the medication numbs the skin. When the procedure needle is inserted, most people report feeling slight discomfort and pressure. With IV sedation, you will feel drowsy and will probably have no memory of the procedure. Because sedation is used, you must arrange to have a driver to take you home, and should not eat or drink for six hours before your scheduled procedure.

How is the epidural blood patch done?

Your blood is drawn to use during the procedure. The nurse will place monitoring devices on your arm and finger, and position you lying face-down. The skin is cleaned with an antimicrobial solution, and the Colorado pain doctor uses a tiny needle to numb the skin over the back. The needle is then inserted into the epidural space using fluoroscopy (read-time x-ray).

What can I expect after the blood patch injection?

After the procedure, you will feel some pressure in the back due to the effect of the blood in the epidural space. After resting in recovery for 30 minutes, a nurse helps you stand up. Most patients report immediate relief of headache pain. Over the next 1-3 hours, your body replenishes the lost spinal fluid, so the headache resolves. We recommend your rest for 1-2 days, and gradually return to usual activities. The epidermal blood patch results are permanent, so should you get a headache after the procedure, you may have to return for another blood patch.

Does the epidural blood patch work?

Many clinical and observational studies have documented the success of the epidural blood patch. It has a 90% efficacy rate and is considered standard of care for a post-epidural injection spinal fluid leak. In a recent study, patients reported high success rates with the blood patch and no complications were observed.

Resources

Banks S, Paech M, Gurrin L. An audit of epidural blood patch after accidental dural puncture with a Tuohy needle in obstetric patients. International Journal of Obstetric Anaesthesia. 2001;10:172–176. doi: 10.1054/ijoa.2000.0826.

Vercauteren MP, Hoffmann V, Mertens E, Sermeus L, Adriaensen H. Seven year review of requests for epidural blood patches for headache after dural puncture: referral patterns and effectiveness of blood patches. Eur J Anaesthesiol. 1999;16:298–303. doi: 10.1046/j.1365-2346.1999.00482.x.

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.