FAQs on Epidural Blood Patch in Philadelphia

 

An epidural blood patch is an injection of the patient’s own blood directly into the epidural space. The spinal cord and nerves are contained in a sack, which is filled with clear fluid (cerebrospinal fluid). The epidural space is the area outside of this sack.

Why is an epidural blood patch done?

There are many reasons why patients have injections directly into the spinal column. Spinal fluid leakages can occur after a diagnostic spinal tap, an epidural steroid injection, or a therapeutic epidural during labor. Some patients experience a headache due to the leakage of cerebrospinal fluid into the epidural space. The epidural blood patch is used to plug the lead so the headache goes away.

How long does the epidural blood patch take?

The actual injection procedure only takes a few minutes. However, the patient will be at the facility for around 2 hours. This includes check-in, talking with the medical staff before the procedure, and observation in the recovery room following the blood patch.

Does the epidural blood patch hurt?

Before the actual epidural injection, the doctor will use a small amount of local anesthetic to numb the skin. This may feel like a pinch, followed by a slight burning sensation. Once the skin and deeper tissues are numbed, the patient only feels a bit of pressure at the injection site.

How is the procedure done?

The patient is positioned on his or her stomach. A nurse and an x-ray specialist will be in the room along with the doctor. The skin and deeper tissues are cleansed with an antiseptic solution before being numbed with a local anesthetic. The doctor inserts the needle into the epidural space using fluoroscopy to assure correct placement. After a nurse obtains a small amount of blood from the patient’s vein, the blood is then injected onto the leak.

What can I expect after the procedure?

After the epidural blood patch, the patient may feel pressure at the back. This is partly due to the effects of the blood sealing the leak. The patient is moved to a recovery area to rest for around 30 minutes. Most patients report immediate relief of headache immediately after the procedure. We advise patients to rest for the remainder of the day, lying flat in bed. Bathroom visits are allowed, however. Before being discharged home, the nurse gives specific discharge instructions.

When can I return to work after the procedure?

After the epidural blood patch procedure, the patient is not permitted to work. However, you are allowed to return to work after 2-3 days.

How long does the effects of the epidural blood patch last?

The effects of the epidural blood patch are permanent. The patient’s own body healing system assists with repairing the cerebrospinal fluid leak. Less than 10 percent of patients require a second epidural blood patch.

What risks and side effects are associated with the epidural blood patch?

The epidural blood patch procedure is a safe, effective technique, but there are some rare risks and side effects. The risks include puncture of the epidural sack, infection, nerve damage, and bleeding. Temporary side effects are pain at the injection site and soreness of the back.

Who should not have the epidural blood patch injection?

Patients who are taking blood-thinning medication should not have an epidural blood patch injection. These drugs include Coumadin, Pletal, Plavix, and heparin sodium.

Is the epidural blood patch effective?

According to a recent research study, the epidural blood patch had a 90% success rate for treatment of spinal headache.

Resources

Madsen S, Fomsgaard J, & Jensen R (2011). Epidural blood patch refractory low CSF pressure headache: a pilot study. Journal of Headache Pain, 12:453-457.

Oedit R, Van Kooten F, Bakker SLM, Dippel DWJ.(2005). Efficacy of the epidural blood patch for the treatment of post lumbar puncture headache BLOPP: A randomized, observer-blind, controlled clinical trial. BMC Neurology, 5:12.