Epidural Blood Patch

Blood is a procoagulant
1. When injected within the epidural space, blood collects on the dural membrane inner surface
2. Injected blood forms a clot, effectively plugging a CSF Leak (Spinal Headache cause)

Patient's blood (20-30 cc) is collected using sterile technique
Epidural needle inserted into epidural space
1. Insertion site at the site of the prior Lumbar Puncture (leak site) or below that site
2. Needle is inserted through ligamentum flavum (crunchy) and then a pop is felt
3. Inject a small amount of saline or air while advancing needle
  1. Resistance is lost when epidural space is entered
  2. Some providers prefer injecting air, as saline may be confused with CSF
4. CSF flow on insertion indicates the needle has punctured the dura (too deep)
  1. Dural puncture complicates >1% of blood patches (even in experienced hands)
  2. Do NOT inject blood into the subdural space (risk of arachnoiditis, infection)
Patient's blood (20-30 cc) is injected via epidural needle into epidural space
1. Blood dissipates at least 9-10 levels while patient is in the supine position

Back Pain (35% of cases)
Dural Puncture (>1%)
Subdural Injection of Blood
1. Risk of arachnoiditis or infection
Recurrent Headache due to loss of blood patch (40% of cases)
1. Patients should avoid straining, bending and heavy lifting after the blood patch