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Anesthesia and analgesia in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Epidural blood patch is considered the definitive treatment for post-dural puncture headache. The technique involves the injection of 10 to 20mL of autologous blood in the epidural space near the original epidural puncture site. Its effectiveness has been reported to be as high as 97% (109). A long-term follow-up study of nonobstetric patients, however, showed that only 61% of patients had a permanent resolution of headache despite an initial success rate of 88% to 96% (110). More recently, a study in an obstetric population showed that only 15% required a repeat blood patch (111). Epidural blood patch has a long history of effectiveness and safety. Nevertheless, if a patient should require more than two blood patches, a search for another cause of headache should be made.
Complications of Obstetric Anaesthesia
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Bhaagya Gunetilleke, Asantha de Silva
The incidence of this extremely distressing and potentially dangerous complication is reduced by the use of narrow gauge (25, 27 gauge) pencil-point spinal needles. Treatment options include hydration with liberal volumes of oral fluid supplemented with intravenous fluids, progressive escalation of the analgesic regime, caffeine, sedatives, and stool softener. Cerebral imaging is required to exclude intracerebral lesions if the headache does not respond to treatment. An epidural blood patch is used in those with a debilitating headache and not responding to conservative management or those with diplopia or hearing impairment.
Epidural and Intrathecal Analgesia
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
The definitive treatment is the epidural “blood patch” that can be performed if these conservative measures are not effective within a reasonable time (this may vary according to patient and their circumstances). This requires insertion of an epidural needle and, in a sterile manner, injection of the patient’s own blood (usually 20 mL) into the epidural space at the level of the previous puncture (Peralta & Devroe, 2017). The resulting epidural blood clot effectively seals the hole through which the CSF is leaking. Relief from the headache is almost immediate in 80–90% of cases; in case of failure it can be repeated. Blood patches may occasionally cause minor backache or headache.
Management of spontaneous intracranial hypotension: a series of 31 cases over 15-years with a challenging outlier
Published in British Journal of Neurosurgery, 2021
Mark McCann, Keith Kelly, Drahoslav Sokol, Mark A. Hughes
Treatment of SIH can be challenging and may be compounded by delayed diagnosis.11 Some patients respond well to conservative management strategies including increased fluid intake, caffeine, and bed rest. However, epidural blood patch has become the primary treatment in cases where conservative management is ineffective.1 EBP involves injecting a 20-60ml volume of the patient’s blood into the spinal epidural space. The intention is that the injected blood redistributes over several levels and encounters and seals the culpable leak, thereby enabling CSF pressure to normalize.12 EBP has been shown to provide sustained improvement to symptoms, especially when the specific site of CSF leak has been demonstrated.5 However, in many cases no clear leak is identified and an untargeted or speculative approach is used. Typically this procedure is done in the lumbar region, due to the increased risk of neurological injury when the cervico-thoracic region is used.13 The clinical efficacy of a targeted versus untargeted approach is yet to be clearly demonstrated, but some evidence suggests targeted EBP is more effective.14 It is not uncommon to need several EBPs in order to achieve persistent symptomatic relief.
Nerve root entrapment with pseudomeningocele after percutaneous endoscopic lumbar discectomy: A case report
Published in The Journal of Spinal Cord Medicine, 2020
Wei Shu, Haipeng Wang, Hongwei Zhu, Yongjie Li, Jiaxing Zhang, Guang Lu, Bing Ni
Management of pseudomeningocele depends on many factors, especially the size and clinical symptoms.14 Small asymptomatic pseudomeningocele may only need to be monitored, as most of these gradually resolve spontaneously. In addition, large expanded pseudomeningocele may require intervention. In any case, conservative methods, including focal compression or bed rest with appropriate positioning, should be suggested as initial treatment. If conservative treatment failed, more aggressive intervention could be considered, including drainage, epidural blood patch and operative revision. Drainage for 3–5 days has a success rate of over 90% in the treatment of CSF leakage, but is associated with a risk of infection. Epidural blood patch has been suggested for pseudomeningocele and postural puncture headache, as clot formation and inflammation help to seal the tiny fistulas.15 If herniation of nerve tissue is suspected, operative revision should be performed as soon as possible.
Bilateral greater occipital nerve block for headache after corrective spinal surgery: a case report
Published in Southern African Journal of Anaesthesia and Analgesia, 2018
Edmundo Pereira de Souza Neto, José Luis Martinez, Kathryn Dekoven, Francoise Yung, Sandra Lesage
It was August Bier who first reported PDPH in 1898. Since then PDPH has been described as a postural, frontal, fronto-temporal or occipital headache, worsened by ambulation and improved by assuming the decubitus position, occurring after dural puncture.1,2 The PDPH can have the accompanying symptoms of nausea, vomiting and neck stiffness.1,2 Many invasive and non-invasive therapies for management of PDPH have been described and epidural blood patch remains the gold standard treatment.1,2 In adults the postulated mechanisms of action of the epidural blood patch include inflammation, as well as tamponade of the dural leakage while simultaneously raising the subarachnoid pressure.9,10 Epidural blood patch is an invasive procedure with approximately 70% prolonged success after initial injection but with potential complications.1,2,11