An epidural blood patch involves injecting the patient's own blood into the epidural space to treat a post-dural puncture headache that has not responded to conservative treatments like bed rest. It has an 85% success rate initially and up to 90% with repeated patches. The procedure involves identifying the epidural space and slowly injecting 5-25mL of blood drawn from the patient over 30-60 seconds. Complications can include worsening headaches from additional dural rents, back pain, or infection at the injection site.

1. EPIDURAL BLOOD PATCH
Ade Wijaya, May 2023

2. INTRODUCTION
 For treatment of CSF leakage
 Conservative treatments: bedrest, analgesics,
NSAIDs, hydration, intravenous (IV) caffeine, or
consumption of caffeinated products
 Epidural blood patch effective with approximately
85% success rate. EBP may be repeated and is
reported to have a 90% success rate
 In rare refractory instances, surgical exploration
and placement of fat graft may be considered

3. EPIDURAL BLOOD PATCH
 Treatment of Post-Dural
Puncture Headache in
people who don't respond
to conservative treatment
 Treatment of Post-Dural
Puncture Headache in
people who will not
tolerate the 7-10 days in
which most dural
puncture headaches
resolve.
 Anticoagulation/coagul
opathy
 Infection at the
injection site
 Patient refusal or lack
of cooperation.
INDICATION CONTRAINDICATION

4. EQUIPMENT AND PERSONNELS
 Equipments: a standard epidural kit and an 18-
gauge or 20-gauge angiocatheter
 Personnels : 3 persons
- Operator
- Second operator for a sterile blood draw and,
possibly
- A third assistant to help with patient positioning.

5. PROCEDURE
 Lateral or seated position, preferably lateral to prevent
symptoms of PDPH
 The back injection site, either from previous dural
puncture or a vertebral interspace one above or below,
is sterilely prepped and draped as well as the extremity
from which blood is to be drawn
 The epidural space is identified in the standard fashion
using loss-of-resistance to air or saline. In particularly
difficult instances the use of C-arm radiography or
ultrasound guidance may be used
 Approximately (5-25 mL) of autologous blood is drawn
from the patient in a sterile fashion. The blood is injected
slowly (30 to 60 seconds) to create a blood patch.

6. COMPLICATIONS
 Failure in 15-20 % procedures
 Worsening of PDPH by inadvertently creating
additional dural rent(s)
 Back pain. Mild to moderate back pain is commonly
reported. This is self-limited, generally resolving in
days and preferable to the discomfort of a PDPH
 Infection at the injection site: fever, malaise,
erythema, or purulence as injected blood may serve
as a nidus for infection.

7. SUMMARY
 Epidural blood patch effective for PDPH treatment
 Treatment of Post-Dural Puncture Headache in
people who don't respond to conservative treatment
and in people who will not tolerate the 7-10 days in
which most dural puncture headaches resolve

8. THANK YOU