![]() It remits after normalization of CSF pressure or successful sealing of the CSF leak. According to the International Classification of Headache Disorders, 3rd edition (ICHD-3), HA attributed to low CSF pressure is described as orthostatic HA caused by low CSF pressure (either spontaneous or secondary) or CSF leakage, usually accompanied by neck pain, tinnitus, changes in hearing, photophobia, and/or nausea. EBP is usually considered in the treatment of moderate to severe HA attributed to low CSF pressure that does not respond to conservative management. Conservative treatment measures include bed rest, intravenous hydration, caffeine supplementation, and analgesics. Ĭonservative treatment for the first 24–48 h is considered the initial management strategy for headache (HA) attributed to low CSF pressure because more than 85% of such HAs resolve with conservative treatment. In 1980, Crawford reported a success rate of 70% using 6–15 ml of blood, compared with 96% when a larger volume of 20 ml was used. Since then, the technique of EBP has undergone substantial modifications. The first EBP, performed with 2–3 ml of blood, was reported by Gormley in 1960 after the observation that bloody taps were associated with reduced post-dural puncture headache (PDPH). EBP may cause an increase in intracranial pressure (ICP) due to the mass effect of the volume of blood injected, causing CSF from the spinal compartment to enter the intracranial compartment. This article reviews the current literature on the indication, contraindication, procedural consideration, post-procedural management, outcomes, and complications of EBP and the considerations for EBP in patients with COVID-19.Įpidural blood patch (EBP) is the injection of autologous blood into the epidural space with the intent of sealing off a dural tear and stopping the leakage of cerebrospinal fluid (CSF). Although many studies on PDPH and SIH have been conducted until recently, only few reviews have summarized the effectiveness of EBP from the perspective of a pain physician. Therefore, it should be carefully planned and performed under C-arm fluoroscopic guidance. EBP is generally safe but may rarely be associated with serious complications. However, prophylactic administration of EBP after accidental dural puncture can hardly be substantiated at present. EBP is usually considered in the management of moderate to severe headache (HA) attributed to low CSF pressure, such as post-dural puncture HA (PDPH), CSF fistula HA, and HA attributed to spontaneous intracranial hypotension (SIH) that does not respond to conservative management. EBP may cause an increase in intracranial pressure due to the mass effect of the injected blood volume, causing CSF from the spinal compartment to enter the intracranial compartment. ![]() Epidural blood patch (EBP) is the injection of autologous blood into the epidural space with the intent of sealing off a dural tear and stopping the leakage of cerebrospinal fluid (CSF).
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