Epidural blood patch. An epidural blood patch is a surgical procedure that uses autologous blood in order to close one or many holes in the dura mater of the spinal cord, usually as a result of a previous lumbar puncture. The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture (spinal tap). A small amount of the patient's blood is injected into the epidural space near the site of the original puncture; the resulting blood clot then patches the meningeal leak. The procedure carries the typical risks of any epidural puncture. However, even though it is often effective,[1] further intervention is sometimes necessary. An epidural needle is inserted into the epidural space at the site of the cerebrospinal fluid leak and blood is injected. The clotting factors of the blood close the hole in the dura. As such, the autologous blood does not repair the leak, but rather treats the patient's symptomology. It is also postulated that the relief of the headache after an epidural blood patch is due to more of a compression effect than sealing the leak. Because the fluid column in the lumbar spine is continuous with the fluid around the brain, the blood exerts a squeeze and relieves the low pressure state in the head. References[edit] ^ Safa- Tisseront V, Thormann F, Malassiné P, et al. ( August 2001). Effectiveness of epidural blood patch in the management of post-dural puncture headache. Anesthesiology 95 (2 334–9. doi:. PMID 11506102. Retrieved from Categories: Surgical procedures.
ASSOCIATED HEALTH CARE COSTS OF EPIDURAL BLOOD PATCHES Introduction The most common complication of an Epidural Blood Patch ( EBP) is back pain. Up to 85% of patients receiving an EBP may experience back pain after the procedure1. There have been case reports of subdural hematoma, infected blood patch, facial nerve paralysis, and permanent spastic paraparesis and cauda equina syndrome. These serious complications are rare but do play a large role in clinical decisions as far as diagnostics imaging studies. In 2013, Ehrenfeld et al published a retrospective review of 43,200 cases examining the incidence of suspected epidural hematoma and the imaging cost associated with epidural catheterization. Their findings included 102 patients (0.24%) undergoing further imaging studies due to suspected epidural hematoma. Of those patients, 6 (0.014%) were confirmed to have an epidural hematoma. Of the 102 suspected cases, a total of 207 imaging studies were performed with a total reimbursement of all the imaging studies totaling approximately 2,000, or about ,120 per study2. To date, there are no studies examining the associated costs of additional hospital admissions for back pain and headache following EBP. This study examines the risk factors associated w/ patient’s who require imaging studies, repeat blood patches, or hospital admissions following an EBP Methods A retrospective cohort study chart review of patients who had an EBP performed was conducted. The study received IRB approval prior to chart review. The number of EBP performed was 196. Recorded data included patient and procedural information, as well as imaging studies performed, hospital admissions, and ED visits for HA or back pain (within 6 months of the EBP need for repeat EBP, and wet tap occurrence during the EBP. Results ~ A total of 184 adult patients underwent an EBP at University of Wisconsin.
D. K. Turnbull*1 and D. B. Shepherd12 1 Academic Anaesthetic Unit, University of Sheffield, K Floor, Royal Hallamshire Hospital, and 2 Jessop Hospital for Women, Sheffield S10 2 JF, UK Corresponding author. E‐mail: totleytiger@yahoo.co.uk Abstract Spinal anaesthesia developed in the late 1800s with the work of Wynter, Quincke and Corning. However, it was the German surgeon, Karl August Bier in 1898, who probably gave the first spinal anaesthetic. Bier also gained first‐hand experience of the disabling headache related to dural puncture. He correctly surmised that the headache was related to excessive loss of cerebrospinal fluid ( CSF). In the last 50 yr, the development of fine‐gauge spinal needles and needle tip modification, has enabled a significant reduction in the incidence of post‐dural puncture headache. Though it is clear that reducing the size of the dural perforation reduces the loss of CSF, there are many areas regarding the pathogenesis, treatment and prevention of post‐dural puncture headache that remain contentious. How does the microscopic pattern of collagen alignment in the spinal dura affect the dimensions of the dural perforation? How do needle design, size and orientation influence leakage of CSF through the dural perforation? Can pharmacological methods reduce the symptoms of post‐dural puncture headache? By which mechanism does the epidural blood patch cure headache? Is there a role for the prophylactic epidural blood patch? Do epidural saline, dextran, opioids and tissue glues reduce the rate of CSF loss? This review considers these contentious aspects of post‐dural puncture headache. Br J Anaesth 2003; 91: 718–29 History Spinal anaesthesia developed in the late 1800s. In 1891, Wynter and Quincke95 aspirated cerebrospinal fluid ( CSF) from the subarachnoid space for the treatment of raised intracranial hypertension associated with tuberculous.
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