scholarly journals Targeted Transforaminal Epidural Blood Patch for Postdural Puncture Headache in Patients with Postlaminectomy Syndrome

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Yu Na Choi ◽  
Sang Ji Kang ◽  
Jin Deok Joo ◽  
Yu Mi Kim ◽  
Jang Hyeok In ◽  
...  
Keyword(s):  
Gold Standard ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Therapeutic Option ◽  
Severe Headache ◽  
Low Back ◽  
Postdural Puncture Headache ◽  
Lower Back ◽  
Interlaminar Approach ◽  
Blood Patch

Postdural puncture headache is a leak of cerebrospinal fluid that lowers intracranial pressure and usually presents as a positional headache. If conservative treatments are not successful, the epidural blood patch is the gold standard of the treatment for dural puncture. The interlaminar approach is the most commonly used technique for an epidural blood patch. This case report describes a patient who was treated with a transforaminal epidural blood patch for postdural puncture headache following an acupuncture procedure on his lower back after two epidural blood patches using an interlaminar approach had failed. The patient underwent an acupuncture therapy for management of chronic low back pain due to postlaminectomy syndrome. After the procedure, the patient had a severe headache and the conservative treatment was not effective. The two interlaminar epidural blood patches at the L2–3 level and at the L3–4 level were failed. We performed transforaminal epidural blood patch at the L3–4 and L4–5 levels on the left side, the site of leakage in the MRI myelogram. His symptoms finally subsided without complication. This case demonstrates that targeted transforaminal epidural blood patch is a therapeutic option for the treatment of postdural puncture headache when epidural blood patch using an interlaminar approach is ineffective.

Post–Dural Puncture Headache

2017 ◽  
Author(s):  
Philip Rubin
Keyword(s):  
Cerebrospinal Fluid ◽  
Epidural Space ◽  
Gold Standard ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Caffeine Intake ◽  
Recumbent Position ◽  
Post Dural Puncture Headache ◽  
Blood Patch

Post–dural puncture headache (PDPH) is a benign but debilitating condition that may occur as a consequence of any dural puncture, whether intentional (as with spinal anesthesia or lumbar puncture) or inadvertent (as with epidural anesthesia). The headache is characteristically unique, as it is postural in nature—worsened when sitting or standing, and markedly improved in the recumbent position. After the puncture, passage of cerebrospinal fluid (CSF) across the dura mater from a pressurized environment (subarachnoid space) to the epidural space, is the initial culprit behind the headache. Noninvasive conservative measures including hydration, analgesics, and caffeine intake are typically offered as initial treatments, but if those measures fail, the “gold standard” epidural blood patch is commonly offered. This procedure entails injection of autologous blood into the epidural space to both halt continued CSF “loss,” and to increase CSF pressure, both of which aid in headache resolution.

Preliminary findings and outcomes associated with the use of a continuous spinal protocol for labor pain relief following accidental dural puncture

2019 ◽  
pp. rapm-2019-100544
Author(s):  
Marcos Izquierdo ◽  
Xiao-Feng Wang ◽  
Karl Wagner III ◽  
Cristian Prada ◽  
Augusto Torres ◽  
...  
Keyword(s):  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Group Versus ◽  
Labor Pain ◽  
Postdural Puncture Headache ◽  
Epidural Group ◽  
Pain Scores ◽  
Blood Patch ◽  
Accidental Dural Puncture ◽  
Spinal Group

BackgroundVarious interventions have shown promise in reducing complications following accidental dural puncture. However, these have yet to be studied as a single, comprehensive protocol. The aim of this study is to compare outcomes associated with the use of a continuous spinal protocol for labor pain relief versus resiting the epidural catheter following accidental dural puncture.MethodsWe reviewed the charts of patients managed via our continuous spinal protocol and compared this group with patients for whom the epidural was resited following accidental dural puncture during the 5-year period prior to implementing our protocol. We assessed incidence of postdural puncture headache, epidural blood patch, frequency of catheter replacement, use of pressors, verbal pain scores at 0, 1, 2, 3, 4 hours following catheter placement, infection rates (meningitis/epidural abscess) and mode of delivery.ResultsThere were 129 women in the continuous spinal protocol group and 52 in the resited epidural group. The incidence of postdural puncture headache was lower in the continuous spinal group versus the resited epidural group (21.7% vs 67.3%, p<0.001), and the incidence of epidural blood patch was lower in the continuous spinal group versus the resited epidural group (12.4% vs 50.0%, p<0.001). Verbal pain scores were consistently lower in the continuous spinal group compared with the resited epidural group at all time intervals studied.ConclusionPatients managed via this continuous spinal protocol had significantly lower incidence of postdural puncture headache and epidural blood patch with more effective labor analgesia following accidental dural puncture.

scholarly journals Transforaminal Epidural Blood Patch

2007 ◽  
Vol 4;10 (7;4) ◽  
pp. 579-582
Author(s):  
Lawrence Weil
Keyword(s):  
Conservative Management ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Epidural Injection ◽  
Low Back ◽  
Epidural Injections ◽  
Transforaminal Approach ◽  
Blood Patch ◽  
Key Words Blood

Spinal headache is an occasional, but painful complication of epidural injection procedures due to dural puncture that allows leakage of CSF from the thecal sac, thereby reducing intracranial pressure. In the event of failure of conservative management, (e.g. abdominal binder, fluids, acetaminophen), an epidural blood patch is often used. This case report describes a patient with spinal headache after a transforaminal selective epidural injection in a post laminectomy patient that was treated with a transforaminal epidural blood patch after the failure of conservative management. The patient underwent left transforaminal epidural injections at L5 and S1 for management of chronic low back pain secondary to post laminectomy syndrome. Three days later, the patient presented with a severe post lumbar puncture headache and failed to respond to conservative management. Interlaminar epidural approach for blood patch was not feasible secondary to prior laminectomy. Transforaminal epidural blood patch was performed utilizing 2 mL of autologous blood at each of the two sites. The patient recovered well without headache. In cases, with inability to perform interlaminar blood patch, a transforaminal approach may be considered. Key words: blood patch, epidural, spinal headache, transforaminal

scholarly journals Incidence of Postdural Puncture Headache after Caesarean Section Comparison Between 25G and 27G Quincke Variety of Spinal Needle

KYAMC Journal ◽  
2017 ◽  
Vol 7 (2) ◽  
pp. 762-769
Author(s):  
Md Afzalur Rahman ◽  
ABM Muksudul Alam ◽  
Muhammad Alamgir Mandal ◽  
Mostofa Kamruzzaman ◽  
Md Asraful Kabir ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Spinal Needle ◽  
Postdural Puncture Headache ◽  
Post Dural Puncture Headache ◽  
Group I ◽  
Blood Patch ◽  
Group Ii

Background: Post dural puncture headache is related to the size as well as type of the spinal needle used90. It is progressively reduced with the use of thinner Quincke type spinal needles.Objective: This was a Quasi-experimental study to compare the incidence of post dural puncture headache after caesarian section with spinal anaesthesia by two typys of needles named 25G and 27G Quincke varities.Methods: This study was conducted in the Department of Anaesthesiology of Shaheed Shurawardy Medical College Hospital, Dhaka. A total number of 60 adult patients with ASA physical status I & II scheduled for elective surgical caesarian section under spinal anaesthesia were enrolled in this study. Patients were randomly allocated equally, 30 in each group into two groups I and II. Patients of Group I, II received 25G and 27G quincke variety of spinal needle respectively. The randomization was double blind except for the anaesthetist performing spinal block. Patient, surgeon and the assessor in the ward was aware of the study. Spinal anaesthesia was performed with 2.0-2.5 ml 0.5% hyperbaric bupivacaine using 25G Quincke spinal needle (Group I),and 27G Quincke spinal needle (Group II) at L3-4 inter-vertebral space. Each patient was assessed daily for four consecutive days following Caesarean section. Incidence and severity of postdural puncture headache (PDPH) was recorded.Result: Seven (7) out of 60 patients developed PDPH giving an overall frequency of 11.6% (Table-2). Frequency of PDPH was 16.7% (5/30) in Group I, 6.7% (2/30) in Group II. In Group I, PDPH was mild in 3 patients (60%), moderate in 1 patient (20%) and severe in 1 patient (20%). In Group II, it was mild in 2 (100%), moderate in 0 and severe in 0 patient. Moderate and Severe PDPH was not observed with 27G Quincke spinal needle (Group II). None of the 60 patients with PDPH required an epidural blood patch. Symptoms were relieved by conventional means in all patients.Conclusion: In current practice epidural blood patch has the highest cure rate for management of PDPH and is usually very well tolerated by majority of patients. Overall, we concluded that when performing spinal anaesthesia for Caesarean section, 27G Quincke spinal needle has definite advantage over 25G Quincke spinal needles as far as frequency and severity of PDPH is concerned. Therefore we recommend routine use of the 27G Quincke spinal needle when performing spinal anaesthesia for Caesarean section.KYAMC Journal Vol. 7, No.-2, Jan 2017, Page 762-769

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