Epidural Blood Patching in Spinal Headache

An epidural blood patch (EBP) is a procedure used to treat a headache you may get following a spinal tap (epidural). This kind of headache is often called a spinal headache. This headache may also be called a postdural puncture headache (PDPH). An epidural blood patch involves injecting a small amount of your own blood into the space near the epidural puncture site.

An epidural blood patch is generally used for treating a person who has received epidural anesthesia and who has symptoms that may include:

  • A headache that is so debilitating that it interferes with your ability to care for your baby.

  • A headache that has not been relieved by 2 to 3 days of:

  • Bed rest.

  • Drinking lots of fluids, including caffeinated drinks.

  • Taking oral medications for pain, including nonsteroidal anti-inflammatory agents. Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver.

  • Neck pain and stiffness that is very severe and associated with vomiting.

  • Hearing loss.

  • Double vision.

An epidural blood patch is not used when:

  • Your symptoms are due to an infection in the lower back (lumbar) area or the blood.

  • You have bleeding tendencies.

  • You are taking certain blood thinning medications.

PROCEDURE

Blood is withdrawn from the arm and injected into the space where the cerebrospinal fluid (CSF) is thought to be leaking. This is the same spot where the epidural anesthetic was injected. When the blood is injected, generally there will be a feeling of tightness in the buttocks, lower back, or thighs.

AFTER THE PROCEDURE

You will be expected to lie on your back for 2 to 4 hours with some pillows under your knees. It is important to lie still while on your back so that a good clot can form. You should avoid any straining, especially right after the procedure.

HOME CARE INSTRUCTIONS

  • Do not carry anything heavier than 15 lb (7 kg) for 2 to 3 weeks.

  • Get as much bed rest as you can for the first 24 hours after the blood patch.

  • Squat rather than bend when picking up items in a low position.

  • Avoid excessive straining. This can cause the patch to blow out and the spinal headache to return.

  • Continue to drink as much as you can, especially beverages with caffeine in them.

  • Report any temperature, back pain, or pain radiating down the legs. Report to your caregiver if the headache returns or if you have any difficulty with your bowels or bladder. Also report any other problems not controlled by medications.

Most patients obtain almost instant relief from the spinal headache. In some, the relief comes on gradually over a 24-hour period. Following the EBP some people experience mild backache for a few days. Less than 2% of people also have a mild, passing sensation of prickly or tingly skin (paraesthesiae), neck pain, or nerve-root pain.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.