Efficacy of the epidural blood patch for the treatment of post lumbar puncture headache BLOPP: A randomised, observer- blind, controlled clinical trial . This postdural puncture headache (PDPH) is typically orthostatic; provoked or aggravated by a vertical or upright position and relieved by a horizontal position. PDPH is probably caused by cerebral spinal fluid leakage through the dural rent, into the epidural space. The leakage causes a decrease in CSF pressure and volume, leading to traction on pain- sensitive structures in an upright position. Besides of headache, the patient may complain of diplopia, tinnitus, dizziness, and myalgia. PDPH may occur immediately after spinal tap, but it starts within 4. PDPH and accompanying symptoms are self- limiting. They generally resolve within 7 days or less, in 8. In a small minority of cases, the symptoms may persist for weeks or even months . During an episode of PDPH the patient may be completely incapacitated and confined to bed. Obviously this has financial, social and psychological repercussions. Different prophylactic measures such as: small needle size, the use of Sprotte's needle, reinsertion of the stylet before withdrawing the needle, and direction of the brevel perpendicular to the dura, have all been shown to reduce the occurrence of PDPH . If, despite the prophylactic measures, PDPH occurs, epidural blood patch (EDBP) may be a beneficial therapeutic intervention. EDBP has gained popularity as a therapeutic measure for PDPH. It involves the injection of 1. Gormly introduced this technique in the 1. He noticed that inadvertent bloody spinal taps were less often complicated by PDPH. He theorised that the epidural bleeding might lead to clot formation over the dural rent, preventing CSF leakage into the epidural space. He therefore continued to treat 6 subjects suffering from PDPH with EDBP, locating the epidural space with the hanging- drop or loss of resistance method. All 6 subjects were relieved of their complaints. Many observational studies followed; they reported success rates of the EDBP for PDPH between 7.
Seven controlled trials concerning prophylactic treatment have been published . One of these studies was not blinded . In this study adverse effects were not mentioned, which prevents firm conclusions. The effectiveness of prophylactic treatment does not seem to have been established firmly. Only one randomised and blinded trial concerning the therapeutic effect of EDBP has been reported . In this study 1. 2 patients, suffering from PDPH for more than 4 days, despite conservative treatment following lumbar puncture, spinal anaesthesia or myelography, were randomly allocated to EDBP or sham treatment. In the placebo group none of the patients noted complete relief of pain. In the treatment group 5 of the 6 patients obtained immediate relief. Subsequently placebo group patients were also treated with an EDBP, resulting in complete relief of PDPH in all patients. The size of the study, the crossover effect, and the absence of any documentation regarding the effectiveness of blinding of the observers and patients, makes it difficult to draw firm conclusions from this study. FAQ’s on Epidural Blood Patch. What is an Epidural Blood Patch? An epidural blood patch is an outpatient procedure done to treat patients with spinal headaches due. Epidural blood patch in the treatment of post-lumbar puncture headache. Lumbar puncture, also referred to as. A Cochrane review on prophylactic and therapeutic blood patching.
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January 2017
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