Epidural Blood Patch
What is an epidural blood patch?
An epidural blood patch is an injection of your blood into the epidural space. The epidural space is not an injection into the spinal cord itself. The spinal cord and spinal nerves are in a “sack” containing clear fluid (cerebrospinal fluid). The area outside this “sack” is called the epidural space.
Why is it done?
There are certain conditions under which patients will have had injections in the spinal column. Examples include an epidural during labor, a diagnostic spinal tap, a therapeutic spinal injection, etc. A small number of patients will experience a severe headache after the procedure, usually worse with standing and better when lying down. This is due to a persistent leak of spinal fluid into the epidural space. Although the headache itself is harmless, it can be very severe and very debilitating. Your doctor may ask you to come to our clinic for an “epidural blood patch”. The injection of a freshly drawn sample of your own blood into the epidural space “plugs the leak” and the headache goes away. Rarely these are needed after certain trauma from things like a motor vehicle accident.
How long does it take to do?
The actual injection takes only a few minutes. Please allow about an hour and a half for the procedure; this will include talking to your doctor before the procedure, signing the informed consent, positioning in the room, and observation by the recovery room nurse afterwards.
What medicines are injected?
There is local anesthetic to numb the skin and any sedatives that you may need.
Will it hurt?
All of our procedures begin by injecting a small amount of local anesthetic through a very small needle. It feels like a little pinch and then a slight burning as the local anesthetic starts numbing the skin. After the skin is numb, the procedure needle feels like a bit of pressure at the injection site. If you wish you can have intravenous sedation or something by mouth prior to the procedure.
Will I “be asleep” for this procedure?
This choice is yours. You can choose to have the procedure done under local anesthetic only. You can also choose to have IV sedation, which can keep you very comfortable. It can range from some drowsiness or you may have little or no memory of the procedure depending upon your comfort level, regardless of the amount of sedation, you must not eat or drink anything for 6 hours prior to this and you must also have a driver when choosing sedation. It is OK to take your medications with a sip of water with either decision.
How is it done?
It is typically done with you lying on your stomach. Your blood pressure and oxygen levels will be monitored. In addition to your doctor and the x-ray technician, there will be a nurse in the room at all times. The skin on the back is cleaned with antiseptic solution. A separate area where a good vein is available is also cleaned with antiseptic solution. A small intravenous catheter is placed in the vein. After your doctor has placed the epidural needle near the affected area, he will draw about 20-25 cc of blood from your vein and will then gradually inject the blood.
What should I expect after the injection?
Immediately after the injection, you may feel pressure in the back. This is due to the effect of the blood in the epidural space. After resting for about 30 minutes, you will be asked to stand up. Typically, most patients experience significant relief immediately. After a few hours, your body will have had a chance to replenish the lost spinal fluid and your headache should continue to get better.
What should I do after the procedure?
We advise patients to take it easy for a day or so after the procedure. You should rest for the first day, you do not have to lay completely and bathroom visits are permitted. Your recovery room nurse will advise you about your activities after going home.
Can I go back to work the same day or the next day?
You should not go back to work the same day. By the next day, most patients will be able to although you might need an extra day to recover.
How long does it last?
The epidural blood patch is permanent. After the injection of your blood, the body’s own healing system should take over and finish repairing the spinal fluid leak. A small number of patients (usually less then 10%) may need to have a second blood patch.
What are the risks and side effects?
Overall, this procedure has very few risks. However, as with any procedure, there are some risks and side effects you should know about. Commonly encountered side effects are increased pain from the injection (usually temporary), rarely inadvertent puncture of the“sack” containing spinal fluid (may not relieve your headaches), infection, bleeding, nerve damage, or no relief from your headache.
Who should not have this injection?
The following patients should not have this injection: if you are allergic to any of the medications to be injected, if you are on a blood-thinning medication (e.g. coumadin, injectable heparin), or if you have an active infection going on.