An epidural is injected into the epidural space, inside the bone spinal canal, but just outside the dura mater. In contact with the inner surface of the dura mater is another membrane, the arachnoid almater, which contains cerebrospinal fluid. In adults, the spinal cord ends around the level of the disc between L1 and L2, while in newborns it extends to L3 but can reach L4. [7] Beneath the spinal cord is a bundle of nerves known as the cauda equina, or “ponytail.” Therefore, lumbar epidural injections carry a low risk of spinal cord injury. When inserting an epidural needle, a needle is threaded between the bones, through the ligaments and into the epidural space without perforating the immediately underlying layer with pressurized cerebrospinal fluid. [7] For administration of EBP due to PDPD, the extent of anterior epidural puncture is sought; [6] Most of the injected blood is distributed through gruals. [8] For HIS with unidentified leaks, L2 and L3 levels are initially targeted. [6] Anesthesia epidural plates. UW Health website.
Available from: patient.uwhealth.org/healthfacts/6098. Retrieved 28 September 2021. Although EBP can be performed by a single operator, it usually requires a second operator for sterile blood collection and possibly a third assistant to assist with patient positioning. An epidural blood patch is a procedure to prevent cerebrospinal fluid from leaking. It uses a small amount of blood to plug the leak. It is performed after a lumbar puncture (LP). The incidence is less than 1% after subarachnoid block, which is performed with a 25-gauge vertebral needle. This percentage increases to nearly 36% when a 20 or 22 gauge needle is used for diagnostic lumbar puncture.
After an accidental puncture of the dura mater with a 17-gauge epidural needle, the incidence of DPPH is approximately 75% to 80%. Risk factors include needle puncture size, age under 60 and female. A typical onset is 24 to 48 hours after a puncture. A headache is often described as intense, similar to a vice in the frontal-occipital region and may be accompanied by cranial nervous symptoms of hearing loss and/or blurred vision. Pathognomonic for PDPH is an exacerbation of symptoms in an upright position with relief in the supine position. If left untreated, more than 90% of PDPHs are self-limiting and resolve spontaneously within 7 to 10 days. Prophylactic PBE has not been shown to reduce the incidence of PDPH after accidental dural puncture in women giving birth for epidural catheter placement. It is usually done with you lying on your stomach.
Your blood pressure and oxygen levels will be monitored. In addition to your doctor and X-ray technician, there will be a nurse in the room at all times. The skin of the back is cleaned with an antiseptic solution. A separate area where there is a good vein is also cleaned with an antiseptic solution. A small intravenous catheter is placed in the vein. Once your doctor places the epidural needle near the affected area, he or she will draw about 20 to 25 cc of blood from your vein and then gradually inject the blood. EBPs are an invasive, but safe and effective procedure – other procedures are sometimes necessary, and repeated patches may be administered until symptoms disappear. This is the standard treatment for PDPH. Common side effects include back pain and headaches. Rebound intracranial hypertension in people with spontaneous intracranial hypotension (HSI) is common, and people with HSI may have less success with EBP. Although the procedure uses blood, it does not pose a significant risk of infection, even in immunocompromised individuals. The procedure is not completely benign – seven cases of arachnoiditis have been reported as a result of administration.
An epidural patch (EBP) is a procedure in which a small volume of autologous blood is injected into a patient`s epidural space to stop cerebrospinal fluid (CSF) leakage. This cerebrospinal fluid is believed to reduce cerebrospinal fluid pressure, especially when the patient is standing, allowing for increased cerebral blood flow through vasodilation, resulting in a characteristic post-puncture postdural headache (PDPH or “vertebral headache”). This activity reviews the indications, contraindications and complications of an epidural patch and highlights the role of the interprofessional team in the treatment of patients with puncture postdural headache. However, there may be an additional dural puncture, which can increase the likelihood of accidental intrathecal blood injection. [3] Prophylactic EBPs do not reduce the risk of developing PDPH. [2] The use of EBP to treat PDPH, although historically considered aggressive, is increasing in adolescents because their headaches are less likely to be resolved by conservative treatment. [9] Fluoroscopic BEPs are more successful than blind BEPs. The failure rate is about 15-20%,[3] although this can be as high as 30%. [13] Common side effects include headache, back pain, neck pain, and mild fever.