A retrospective review of an epidural blood patch database: the incidence of epidural blood patch associated with obstetric neuraxial anesthetic techniques and the effect of blood volume on efficacy

Booth, Jessica L.; Pan, Peter H.; Thomas, Julia Adeney; Harris, Lynnette; D’Angelo, Robert

doi:10.1016/j.ijoa.2016.05.007

Cited by 46 publications

(24 citation statements)

References 16 publications

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“…In a study including seven children aged 12 years and younger, relief of symptoms was reported with EBP in all children. 16 Booth et al 14 In the present study, 15.3% (four patients) had application of a second EBP, and it was similar to the literature with a success rate of 75%.…”

Section: Discussionsupporting

confidence: 88%

“…In a study including seven children aged 12 years and younger, relief of symptoms was reported with EBP in all children . Booth et al reported that 16.7% (66/394) of patients had a second EBP applied, and 9% (6/66) of these required a third EBP to be applied. Paech et al reported that a second EBP was required up to 30% of the time.…”

Section: Discussionsupporting

confidence: 86%

“…The success rate for EBP in adult patients was reported as 61%, 85% in pediatric patients, 85% in elderly patients, and 67% and 70% in obstetric patients . In our series, children with CP also show that severe spinal headache may develop after ITB pump implantation, and EBP can be as effective in these children as in adults.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent study, it was reported that with use of 30 mL of blood volume in obstetric patients, many of these injections were difficult and did not achieve better effects. In children, volumes are recommended based on body weight, whereas adults are more commonly expressed in mL …”

Section: Discussionmentioning

confidence: 99%

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The effectiveness of epidural blood patch in patients with cerebral palsy treated with intrathecal baclofen implantation

İmerci

Rogers

Dixit

et al. 2020

Pediatric Anesthesia

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Background Cerebrospinal fluid leak and postdural puncture spinal headache following intrathecal baclofen therapy are known complications. Although primary treatments are conservative, epidural blood patch is an alternative in patients with persistent and severe symptoms. Aim The purpose of this article is to review the effectiveness of epidural blood patch for the treatment of spinal headache and cerebrospinal fluid leak associated with intrathecal baclofen treatment in children with cerebral palsy. Methods Our database was reviewed for epidural blood patch in 341 pediatric patients with cerebral palsy who underwent primary intrathecal baclofen treatment from 2004 to 2018 at one institution. The number of patches, time frame of treatment, and effectiveness of the epidural blood patch were collected. All patients treated with epidural blood patch were evaluated for primary and secondary intrathecal baclofen‐related procedures, and subsequent treatment of intrathecal baclofen associated with cerebrospinal fluid leak and spinal headache. Results Twenty‐nine epidural blood patch procedures were performed on 26 patients who had received intrathecal baclofen procedures. Of these 26 patients, four had a secondary epidural blood patch. The incidence of spinal headache/cerebrospinal fluid leak was 31% (107/341), and 81/107 (76%) patients with spinal headache/cerebrospinal fluid leak responded to conservative treatments. Success rate for initial epidural blood patch was 79.3% (23/29). The second epidural blood patch was performed in four patients after failure of initial epidural blood patch. Second epidural blood patch success rate was 75% (3/4). Conclusion Spinal headache and cerebrospinal fluid leak are known complications after intrathecal baclofen treatment in children with cerebral palsy. When conservative treatments are unsuccessful, epidural blood patch can be used with confidence for these patients. In patients with ongoing symptoms, it is possible to obtain success by repeating the epidural blood patch to continue intrathecal baclofen treatment and avoid aggressive surgery.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The effectiveness of epidural blood patch in patients with cerebral palsy treated with intrathecal baclofen implantation

İmerci

Rogers

Dixit

et al. 2020

Pediatric Anesthesia

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show abstract

“…Because the epidural space varies in capacity and compliance, patients experienced pain during injection before a volume of 30 ml was administered. Similarly, a recent retrospective review by Booth et al [81] reported that increasing the blood volume up to 30 ml did not reduce the need for a repeated epidural blood patch, when the final volume was primarily determined by back pain during injection.…”

Section: Treatmentmentioning

confidence: 96%

Postdural puncture headache

Kwak

2017

Korean J Anesthesiol

143

128

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Postdural puncture headache (PDPH) is a common complication after inadvertent dural puncture. Risks factors include female sex, young age, pregnancy, vaginal delivery, low body mass index, and being a non-smoker. Needle size, design, and the technique used also affect the risk. Because PDPH can be incapacitating, prompt diagnosis and treatment are mandatory. A diagnostic hallmark of PDPH is a postural headache that worsens with sitting or standing, and improves with lying down. Conservative therapies such as bed rest, hydration, and caffeine are commonly used as prophylaxis and treatment for this condition; however, no substantial evidence supports routine bed rest and aggressive hydration. An epidural blood patch is the most effective treatment option for patients with unsuccessful conservative management. Various other prophylactic and treatment interventions have been suggested. However, due to a lack of conclusive evidence supporting their use, the potential benefits of such interventions should be weighed carefully against the risks. This article reviews the current literature on the diagnosis, risk factors, pathophysiology, prevention, and treatment of PDPH.

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