Comparison of Efficacy of an Epidural Blood Patch in Patients with Spinal Leakage of Cerebrospinal Fluid

Abstract

BACKGROUND: The leakage of cerebrospinal fluid (CSF) can be encountered spontaneously or after procedures such as epidural or spinal anesthesia, intrathecal chemotherapy, CSF tapping, or other various spinal procedures. The leakage of CSF can lead to intracranial hypotension, which is associated with an orthostatic headache. For such patients with this type of headache, an epidural blood patch is the treatment of choice.

OBJECTIVE: The purpose of this study is to compare the clinical features and efficacy of an epidural blood patch for patients with spinal leakage of CSF.

STUDY DESIGN: Retrospective study.

SETTING: University hospital inpatients referred for consultation to the pain clinic

METHODS: Identification of patients with orthostatic headache was performed using the program Clinical Data Warehouse (CDW) v 2.5. Search word in CDW for analysis was "epidural blood patch." We carefully evaluated the demographics, etiology, clinical features of headache, associated phenomena other than headache, level and types of CSF leakage, and frequencies and outcomes of epidural blood patches. We allocated patients into 2 groups according to the cause of headache: spontaneous intracranial hypotension (group SIH) and post-dural puncture headache (group PDPH).

RESULTS: The number of patients needing repeated epidural blood patches was significantly higher in the SIH group SIH in the PDPH group (P = 0.007). In the PDPH group, a targeted epidural blood patch was possible in 100% of the cases, whereas it was possible in only 66.7% of the patients in the SIH group, indicated by previous examination (P < 0.001). Forty patients (90.9%) and 17 patients (70.8%) achieved complete recovery from headache after a single epidural blood patch in the PDPH group and SIH group, respectively (P < 0.001).

LIMITATION: The number of patients allocated to each group was not balanced because of the retrospective design.

CONCLUSION: Most patients in the PDPH group required a single epidural blood patch to achieve complete recovery from headache. However, patients in the SIH group required repeated epidural blood patches for complete pain relief.