Epidural blood patch for management of postdural puncture headache in adolescents

Abstract

Background: In some patients spinal puncture (SP) is followed by postdural puncture headache (PDPH). When the symptoms of PDPH are severe and are not relieved within a few days an epidural blood patch (EBP) might be performed. The aim of this survey was to review requests for EBPs and to evaluate the effectiveness of EBP in patients aged 13-18 years during a 6.5 year period ending in June 2001.

Methods: The Information System Patient Measures Database was interrogated to identify patients who were referred for EBP. After identification, the patients' medical records were reviewed in detail for the characteristics of PDPH and other symptoms, and for the effectiveness of the EBP.

Results: Forty-two EBPs were performed after 40 SPs on 37 patients (24 girls, 13 boys). Epidural blood patches were performed twice in five patients. The reasons for repeating the procedure were repeat SP with new PDPH in three patients and an unsatisfactory effect in two patients. Twenty-eight of the 40 spinal punctures (70%) had been performed for diagnostic use and 10 (25%) for spinal anesthesia. Two patients (5%) developed PDPH after inadvertent dural puncture with an epidural needle. In 37 cases the criteria for PDPH were fulfilled, and one patient had a cerebrospinal fluid fistula headache. Two-thirds of the girls had associated symptoms of headache compared with one-third of the boys. Epidural blood patch was performed 1-22 days after SP with 0.2 ml/kg (mean) of autologous blood injected into the epidural space. The success rate of the first injection was 37 out of 40 EBP (93%), and the second injection was effective in both patients with recurred PDPH.

Conclusion: Epidural blood patch seems to be an effective and safe procedure in adolescents for treating severe and persistent PDPH.