Epidural blood patch: Comparison of fluoroscopic guided technique versus non-fluoroscopic (blind) technique

Bhandari, Arun; Anand, Abhay; Khan, Farooque; Ellias, Mazin

doi:10.1163/15685690152385781

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…Only three patients with blind technique did not respond to the first EBP. 4 The authors concluded that they could not recommend fluoroscopic EBP for every patient with postdural puncture headache and would reserve it for those with altered anatomical landmarks or those who did not respond to the first patch.…”

Section: Bandhari Et Al Compared Fluoroscopic-guided Technique Ver-mentioning

confidence: 99%

Arachnoiditis following epidural blood patch—An avoidable rare complication due to blind technique: A response

et al. 2021

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Section: Bandhari Et Al Compared Fluoroscopic-guided Technique Ver-mentioning

confidence: 99%

Arachnoiditis following epidural blood patch—An avoidable rare complication due to blind technique: A response

et al. 2021

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“…There is evidence to support that patients with COVID-19 improve respiratory mechanics in the prone position (30). Furthermore, a fluoroscopic approach may be preferable as it has been shown to be more precise and associated with a higher success rate than a blind technique (31). Prone positioning may also offer greater distance for the care team from the patient's face and may be more comfortable for the patient.…”

Section: Risks To Treatment Teammentioning

confidence: 99%

Considerations for Epidural Blood Patch and Other Postdural Puncture Headache Treatments in Patients with COVID-19

et al. 2020

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Background: A primary concern in the use of EBP in these patients is the possibility of seeding the virus in the CNS. Another important concern is related to the known hypercoagulable state in COVID-19 positive patients and associated organ dysfunction that may alter the metabolism of anticoagulants. The safety of the providers performing the EBP, the position of the patient and choices for image guidance (blind, fluoroscopic) are also key considerations to review. It is also important to explore the current state of knowledge about using allogenic instead of autologous blood as well as emerging techniques to eliminate the coronavirus from the blood. Objectives: In this article we pose the questions of how to manage PDPH in the COVID-19 positive patient and more specifically, the use of epidural blood patch (EBP). Methods: Literature review. Results: EBP is usually considered after the failure of conservative and pharmacological treatments. Because of the additional risks of EBP in COVID-19 patients it is important to also consider less traditional pharmacological treatments such as theophylinnes and cosyntropin that may offer some additional benefit for COVID-19 patient. Finally, other interventions other than EBP should also be considered including occipital nerve blocks, sphenopalatine ganglion blocks (infratemporal or transnasal). Limitations: A narrative review with paucity of literature. Conclusion: Going forward, an effective treatment for COVID-19 or a safe vaccine and a deeper understanding of the pathophysiology of the virus will certainly change the risk calculus involved in performing an EBP in a COVID-19 patient. Key words: COVID-19; PDPH; Epidural Blood Patch; Post-dural Puncture Headache

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“…3 Although many EBPs are performed with a "blind" technique using anatomic landmarks and loss of resistance, fluoroscopic guidance is advocated and may result in better outcomes. 4 Precise and safe access to the spinal epidural space relies on image guidance with either a fluoroscope and performance of a contrast epidurogram or CT where air contrast can be used to confirm appropriate position.…”

mentioning

confidence: 99%

Arachnoiditis following epidural blood patch—An avoidable rare complication due to blind technique

Chazen

Amrhein

2021

Headache

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Epidural blood patch: Comparison of fluoroscopic guided technique versus non-fluoroscopic (blind) technique

Cited by 5 publications

References 11 publications

Arachnoiditis following epidural blood patch—An avoidable rare complication due to blind technique: A response

Arachnoiditis following epidural blood patch—An avoidable rare complication due to blind technique: A response

Considerations for Epidural Blood Patch and Other Postdural Puncture Headache Treatments in Patients with COVID-19

Arachnoiditis following epidural blood patch—An avoidable rare complication due to blind technique

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