Letter: The use of blood patch for post-spinal headaches

Epidural blood patch in the treatment of post-lumbar puncture headache

Post-lumbar puncture headache is a common complication of dural puncture. Treatment of severe cases with an epidural 'blood patch'--injection of 10-20 ml autologous blood into the epidural space at the site of the dural puncture--is an effective and safe method with few and generally mild complications. The method has been used by anesthesiologists for many years with good results, but only rarely by radiologists, neurologists and other specialists who often perform lumbar punctures. The technique of 'blood patching,' its indications, effects, and complications and the epidural blood patch as post-lumbar puncture headache prophylaxis are discussed.

The management of headache following accidental dural puncture in obstetric patients

The progress and management of fifty-eight obstetric patients who received an accidental dural puncture is described. Headache attributable to dural puncture occurred in 85% of patients managed conservatively. Epidural infusion or repeat epidural bolus injections of saline after delivery reduced the incidence to 65%. A therapeutic autologous blood patch using 8-10 ml of blood was performed in 28 patients at least 24 hours after the accidental puncture. Dramatic and permanent relief occurred in 75% following this procedure. A repeat blood patch was effective in four patients and ineffective in the remaining two. Mild and temporary back stiffness and one case of moderately severe radicular pain for three days were the only complications noted after the procedure. The pathophysiology and treatment of dural puncture headache is reviewed. Reduction of pressure differential across the dural puncture site is most useful in the first 24-48 hours. Persistent and severe headache occurring after this should be treated with blood patch.

Prophylactic blood patch does not prevent post lumbar puncture headache

Of 86 patients in whom accidental puncture of the dura occurred during insertion of a needle for induction of epidural analgeisa for labour and delivery, 11 received a prophylactic blood patch at the completion of delivery. Of the 75 patients with no prophylactic blood patch, 59 per cent developed post-lumbar-puncture headache, while 54 per cent of those who had a prophylactic blood patch developed headache. The prophylactic blood patch appears to have no value in preventing post-lumbar-puncture headache in this small group of patients.