The epidural blood patch is an injection of the patient’s own blood into the epidural space. The spinal cord and spinal nerves are in a sac that contains cerebrospinal fluid. The immediate area outside of this sac is the epidural space.
Many procedures involve injection into the spinal column, such as an epidural during labor, a therapeutic spinal injection, and a diagnostic spinal tap. A few patients who have these procedures experience a severe headache afterwards, which is called a post-dural puncture headache (PDPH). This headache is usually worse with standing up and improves with lying down. The headache is a result of a small leak of cerebrospinal fluid. The epidural blood patch involves injection of a freshly drawn sample of the patient’s own blood that is used to plug the leak.
The actual injection only takes just a few minutes, but you should allow around 2 hours for the entire procedure. This time involves the check-in, going over the informed consent, talking to the doctor, positioning in the procedure room, and observation by a recover room nurse afterwards.
The injection involves a local anesthetic to numb the skin. No other medications are used during the epidural blood patch procedure. This procedure does not involve general anesthesia (being put to sleep).
The procedure begins with injecting a small amount of local anesthetic through a tiny needle. You can expect to feel a slight pinching sensation follows by a burning sensation as the anesthetic begins numbing the skin. Once the skin is fully numb, you will only feel pressure at the injection site. If you have pain during the procedure, be sure to notify the doctor.
The doctor will conduct a physical examination and take a medical history. In addition, a member of the staff will explain the risks and benefits of the procedure, and have you sign a consent form. You should arrange for a ride home, and cannot eat or drink 6 hours before the procedure. The doctor must be aware of what medications you are taking, as certain blood-thinning drugs are held before the procedure.
The procedure is done with the patient lying on his/her stomach. A nurse will monitor you oxygen levels, pulse rate, and blood pressure during the procedure. This skin is cleansed with an antiseptic solution, and an anesthetic is used for numbing. A nurse will place a small intravenous catheter in your vein and draw some blood. The doctor inserts a small needle into the epidural space using x-ray guidance for correct placement. The doctor gradually injects the blood to seal the leak.
Immediately after the epidural blood patch injection, you will feel pressure in the back. A nurse will monitor you while you rest for 20-30 minutes. You may experience immediate relief from the headache. If not, as your body replenishes the lost spinal fluid, the headache should resolve. We advise patients to take it easy for two days. You should stay flat in the bed for the rest of the day, and gradually return to activity the following day.
The epidural blood patch is a very safe procedure with few risks. However, encountered side effects include increased pain from the injection, infection, bleeding, no relief of headache, and nerve damage.
Patients who cannot have this procedure include:
Many clinical studies report a success rate between 70 and 90% for the epidural blood patch.