FAQ’s on Epidural Blood Patch
Occasionally when receiving an injection into the spinal epidural space, the needle used is capable of tearing the dural tissue. Tearing can occur with either a diagnostic or therapeutic spinal injection, a myelogram, or during an epidural given to a woman in labor. Dural tearing leads to leakage of spinal fluid into the surrounding epidural space, causing a sudden and severe headache which typically produces pain for patients. A large number of our patients have found these headaches to be debilitating, and it is important for patients to report any headaches that follow a lumbar procedure to their physician immediately.
An epidural blood patch works to stop this leakage by using a sample of blood taken from the patient as an injectable into the leaking tissue. While a leak is present, the internal pressure of the epidural space is reduced. This lowered pressure is the direct cause of headaches for patients that, while not dangerous, can be an extremely painful experience. The injected blood forms a patch over the epidural tear, stopping the leak and providing symptomatic relief for both the headaches and the pain.
What will an Epidural Blood Patch treat?
The primary purpose of an epidural blood patch is for the treatment of spinal fluid leakage, and the headaches that result from it, due to a tear in the dural tissue during a spinal injection. Blood patches function by injecting the patient’s blood directly into the dural tear, where blood will form a tissue patch to plug the leak. Once the leak has been patched, the intraspinal pressure should normalize causing headaches to dissipate and no longer cause pain for patients.
In many cases, epidural blood patches are performed only after other conservative methods have been tried. Following numerous clinical trials, epidural blood patches have been deemed the gold standard in treating headaches caused by dural puncture (Epidural blood patch is the gold standard treatment for dural puncture headache, 2012).
How is an Epidural Blood Patch performed?
Patients will typically be required to spend no more than 30 minutes receiving their injection, with the over-all procedural time close to two hours. Patients will be asked to lie face down to provide spinal access for the physician, who will insert two intravenous lines into the patient: one for the direction injection of fluids and medication, and the second used for blood withdrawal to create the injectable.
After properly positioning the patient, the injection site will be numbed with a local anesthetic. An injection needle will be guided as near to the dural tear as possible, with contrast used to ensure accurate needle placement. In many cases, the needle will also be guided with fluoroscopic imaging. After correct positioning, a sample of blood will be drawn from the patient and immediately placed into the injection needle for injection into the dural tear. Patients are strongly encouraged to let their physician know if any pain or discomfort is felt.
How well does an Epidural Blood Patch work?
The effectiveness of these patches has been studied and tested with numerous clinical trials, culminating in the statement that the blood patch sets the bar in treating headaches caused by dural tear. (Effectiveness of epidural blood patch in the management of post-dural puncture headache, 2001) Epidural blood patches are the primary method of treating spinal headaches caused by dural leakage, and a very safe and reliable means of obtaining symptomatic relief.
What are the risks of an Epidural Blood Patch?
There is a small risk of soreness, bleeding, or infection at the site of injection. Patients who develop a fever greater than 100 degrees Fahrenheit, or who develop swelling or redness at the site of injection, may be experiencing the signs of an infection. The largest is that the patch will not be effective, and that subsequent patches may be required to stop leakage.