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Fluoroscopically guided epidural blood patch in patients with postdural puncture headache after spinal and epidural anesthesia

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Abstract

Postdural puncture headache (PDPH) is one of the major complications after spinal and epidural anesthesia. An epidural blood patch (EBP) may be applied when PDPH persists regardless of conservative treatment. We describe the results of management including fluoroscopically guided EBP in a series of patients with moderate to severe PDPH. From January 2007 to December 2009, PDPH developed in 15 of 3,381 patients (0.44%) who received epidural or spinal anesthesia: 5 (0.21%) after general anesthesia combined with epidural anesthesia, 8 (0.81%) after spinal anesthesia, and 2 (3.14%) after combined spinal and epidural anesthesia. Of 15 patients, PDPH was relieved without the EBP in 9 patients and 6 patients required the EBP. EBP was performed under fluoroscopy in a prone position; a 4:1 mixture of autologous blood and contrast medium was injected to cover the site of dural puncture. The success rate of fluoroscopically guided EBP was 100% with a mean blood volume of 7.2 ml. No complications were associated with EBP except for a mild backache. Fluoroscopically guided EBP may be successfully and safely performed to treat persistent PDPH with a relatively small volume of blood for epidural injection.

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References

  1. Cesur M, Alici HA, Erdem AF, Silbir F, Celik M. Decreased incidence of headache after unintentional dural puncture in patients with cesarean delivery administered with postoperative epidural analgesia. J Anesth. 2009;23:31–5.

    Article  PubMed  Google Scholar 

  2. Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003;91:718–29.

    Article  PubMed  CAS  Google Scholar 

  3. Ergun U, Say B, Ozer G, Tunc T, Sen M, Tufekcioglu S, Akin U, Ilhan MN, Inan L. Intravenous theophyline decreases post-dural puncture headaches. J Clin Neurosci. 2008;15:1102–4.

    Article  PubMed  Google Scholar 

  4. van Kooten F, Oedit R, Bakker SLM, Dippel DWJ. Epidural blood patch in post dural puncture headache: a randomized, observer-blinded, controlled clinical trial. J Neurol Neurosurg Psychiatry. 2008;79:553–8.

    Article  PubMed  Google Scholar 

  5. Sudlow C, Warlow C (2004) Epidural blood patching for preventing and treating post-dural puncture headache. 3rd edn. Wiley, Chichester. Cocrane Database Syst Rev 2002;2:CD001791.

  6. Lybecker H, Djernes M, Schmidt JF. Postdural puncture headache (PDPH): onset, duration, severity, and associated symptoms. An analysis of 75 consecutive patients with PDPH. Acta Anaesthesiol Scand. 1995;39:605–12.

    Article  PubMed  CAS  Google Scholar 

  7. Kang SB, Goodnough DE, Young KL, Olson RA, Borshoff JA, Furlano MM, Krueger LS. Comparison of 26- and 27-G needles for spinal anesthesia for ambulatory surgery patients. Anesthesiology. 1992;76:734–8.

    Article  PubMed  CAS  Google Scholar 

  8. Ostherimer GW, Palahniuk RJ, Shnider SM. Epidural blood patch for postlumbar-puncture headache. Anesthesiology. 1974;54:459–63.

    Google Scholar 

  9. Crawford JS. Experiences with epidural blood patch. Anesthesia. 1980;35:513–5.

    Article  CAS  Google Scholar 

  10. Safa-Tisseront VS, Thormann F, Malassine P, Henry M, Riou B, Coriat P, Seebacher J. Effectiveness of epidural blood patch in the management of post-dural puncture headache. Anesthesiology. 2001;95:334–9.

    Article  PubMed  CAS  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan

    Masahiko Kawaguchi, Keiji Hashizume, Keisuke Watanabe, Satoki Inoue & Hitoshi Furuya

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  1. Masahiko Kawaguchi
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  2. Keiji Hashizume
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  3. Keisuke Watanabe
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  4. Satoki Inoue
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  5. Hitoshi Furuya
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Correspondence to Masahiko Kawaguchi.

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Kawaguchi, M., Hashizume, K., Watanabe, K. et al. Fluoroscopically guided epidural blood patch in patients with postdural puncture headache after spinal and epidural anesthesia. J Anesth 25, 450–453 (2011). https://doi.org/10.1007/s00540-011-1135-2

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  • DOI: https://doi.org/10.1007/s00540-011-1135-2

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