[Blood-patch: immediate effective remedy for headaches secondary to dura mater injury]

Abstract

Objective: The aim of this study was to evaluate if bed rest during 2 h in a supine posture is required to improve the efficacy of the blood-patch procedure.

Patients and methods: Patients whose postdural puncture headache remained distressing 48 to 72 h after dural tap despite the use of stage II WHO painkillers were included in this prospective single center study lasted for a 2-year period. The patient's own blood injection in the epidural space was performed until discomfort or pain in the lumbar area occurred or was limited to 20 ml if no such sensation was observed. After blood had been injected, the patient was allowed to stand up as soon as desired, under close observation. The patient was then discharged to the ward for a 48 h follow-up.

Results: Nine female and 12 male patients (age: 16-35 years) were included. Headache occurred after spinal anaesthesia in 16 cases, epidural analgesia for delivery in two cases and lumbar puncture by during neurological workup in three cases. Autologous blood volume injected was 20 ml in 19 patients and was reduced to 18 and 16 ml, respectively, in two patients due to lumbar pain. All blood-patches were technically uneventful and led to immediate headache relief, associated with a feeling of wellbeing and desire to stand up. The 48 following hours were without any incident and painkillers were no more needed.

Conclusion: In this prospective study, blood-patch was mainly performed after spinal anaesthesia and was associated with a high rate success. This encouraging result suggests that recumbent position maintained for 2h after the blood-patch is performed might not be necessary to obtain full efficacy.