EPIDURAL BLOOD PATCH
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- čas přidán 29. 08. 2024
- All patients and anesthesia providers need to know about Epidural Blood Patch: What, When, Why and How. It provides a complete info for patients and anesthesia trainees with a hint of an attitude. Feel free to SHARE, SUBSCRIBE, and never miss new videos on NYSORA Channel!
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Disclaimer:
Medicine is an ever-changing science. As new research and clinical experience broaden, changes in treatment and drug therapy are required. The authors and publishers have checked with sources believed to be reliable in efforts to provide accurate information within the available or accepted standards of care. However, given the possibility of human error or changes in medical practice, neither the authors nor the publisher, nor any other party involved in the preparation of this platform warrants that the information contained herein is in every aspect accurate or complete, and they disclaim all responsibility for any errors or omissions for the results obtained from the use of the information contained in this work. Readers are advised to confirm the information contained herein with other sources. For example, readers are advised to check the product information of each drug mentioned, and that any information contained on NYSORA's CZcams channel is accurate.
just watched a tiktok of a girl who got a lumbar puncture and was told to lie completely flat for 2-3hrs. i got intrigued about why the headaches happen, and why sitting up triggers them. thanks for this video!
Yeah they told me to lie flat but didn't explain the reason. I wish I would have known, I would have been completely still for 4 hours to prevent these headaches lol
Good video. Once the epidural is placed, I always aspirate to make sure it is not intrathecal before I administer blood. The last thing you want to do is to inject blood intrathecally. The pdph will be remembered as a very benign thing compared to it
Oooops. Indeed. Good point. Greetings!
Exactly! Lifetime of siderosis vs pdph.
This video is so good that it makes me feel bad about all those years without NYSORA. This channel should be mandatory in all med schools worldwide.
Dear Alptekin! Thank you so much for your kind words! Keep watching!
Great video! Super informative about the pathology of the headache! I’m an ER nurse and we sometimes have to assist with blood patches! It’s always great to be able to sound knowledgeable to your patients in order to provide them with reassurance about the procedure itself. Thanks again! Awesome video! Love your content!
Hello Monica! Thank you for your kind feedback. It's comments like these that motivate us to keep making more content! Greetings from NYSORA.
You are the best anesthesiologist doctor I have never seen good luck 👍
May please make lessons about IV drugs and what's use for please
Just did one of these yesterday. (BTW…It wasn’t me that wet tapped them). Sometimes getting the blood can be the most difficult part of it. Very timely video. Ty.
If you're in the ER/wards you can have their nurse get blood for you when you feel the loss of resistance. If their nurse is busy (in the ER or the wards/floor) then I will not perform it - only when they have a dedicated second hand will I entertain their request. In the meantime, the patient can have conservative treatment if they haven't already. I have seen colleagues perform A-lines prior to a blood patch and get blood that way (which has it's risks as you know).
It can happen to everyone. Greetings and thanks for watching!
Listen to the patient if they know there's an area/vein that gives blood better than another. I had to have the big spinal needle twice because the man in charge of getting blood thought he could get a vein I knew didn't work, I told him but he ignored me and then couldnt do it. Luckily he listened to me after that, went to my one big vein and we got through it. My case was due to spontaneous intracranial hypotension, not spinal anaesthesia. Its really like magic...feeling the pressure of the blood going in and instantly you feel your brain go from intense agony...to it feeling like it's being covered in warm honey and the pain falls away. Unfortunately I might need another. Thank you for the work you do.
First you get the blood, then you do the epidural. You have plenty of time before the blood coagulates.
The last EBP I did, the lab tech who was going to draw the blood looked uncertain. I grabbed the ultrasound and mapped out a large AC vein for her ahead of time with a marking pen.
This is the best video content on epidural blood patch I have encountered by far. We would love to see more NYSORA content on labor analgesia. The use of adjuncts, such as clonidine or dexmedetomidine, is a particularly hot topic at my practice location.
Hi Simon. Thank you , and appreciate the suggestion. Will DO! THere's a lot more on RA and the topic of you interest also on this growing NYSORA's reference. Community discussions are also cool as well. nysoralms.com/courses/nysora-compendium-of-regional-anesthesia/
i suffered from PDPH post lumbar puncture. I refused the blood patch but opted for the bioccipital nerve block and it was AMAZING. Instant relief and was able to ambulate right after
Thank you for sharing. It is definitively worth trying before the blood patch IMO. Does anyone else have an experience on this treatment modality for PDPH? pubmed.ncbi.nlm.nih.gov/25441250/
there is nothing more beautiful than feeling the epidural space by this method, it's magic
Indeed - there is something artisanal about it. Greetings!
It’s excruciatingly painful, worst pain of my life I would have rather had my son with no medicine that get a blood patch again
Great topic, thanks!
Have had some excellent results with aminophylline. Oral dosing.My patients are given a choice, trial with medication or BP.
Limited numbers here. 1-2 patients relief within 24 hours of meds, 1-2 requiring 48 hours. A couple of patients frustrated at 24+ hours and requested BP.
Estou a 4 anos e meio com a cefaléia pós punção, desespero! (Fiz 2 blood patch) 1 resolveu por 18 dias, o outro por uns 2 anos mais ou menos e agora não querem fazer outro, não sei como faço para me livrar desta dor!
It's the first time I've seen it. Thank you Sir
Hi Daniel, our team is always really glad to help medical professionals everywhere! New videos are going to be up soon - we're hoping to catch you in the comments there as well. Best wishes, the NYSORA team
Great video, I had a very scary experience, when a "Doctor" performed a spinal tap and did so much damage, I ended having a seizure, the pain was unbearable, I was vomiting, dizziness, blurry vision, photo phobia. I was in and out of the ER a whole week and no-one but a great Doctor in a different ER came right away and told me I was going to get a blood patch, the anesthesiologist was so amazing, I did not even feel it. I still have side effects, fainted once, nausea, dizziness, back and leg pain, weakness on legs.
Hi Sandy, We are sorry to hear that. We share medical education for professionals across the globe, however, and advise you to speak to a local professional on how to proceed in your specific case. Kind regards, the NYSORA team.
I had a spinal tap done last Saturday and it was a horrible experience. I have 3 herniated discs and scoliosis as the base of my spine and the doctor performing it allowed the junior doctor to lead the procedure. She struggled for over 15 minutes before the senior doctor took over and he instantly hit a nerve. Now my headaches are very strong 6 days later and I'm kinda panicking that I'm going to need the blood patch because the thought of another needle in the same place is awful.
@@laingy166I hope every thing went well for you.
I recently read about a case report where the blood patch was performed by interventional radiologists.
I would imagine that this could significantly reduce the risk of repeated dura perforation. On the other hand, there is the radiation exposure..
Hmm. If the report was about interventional pain docs, I'd say possibly. Regardless, one-off good outcome is still a win for the patient. All's well that ends well. Thank you for sharing - can you share the report/reference. Thank you
We perform CT-guided epidural blood patch regularly in our Neuroradiology Department with minimal radiation exposure, especially in cases with spontaneous intracranial hypotension. If you check Pubmed you can find other Neuroradiology departments that do it as well...
Thanks
In epidural blood patch, we intentionally inject blood into the epidural space. But there is one other complication of epidural, that is epidural hematoma, where blood collection happens in the epidural space which can compress the spinal cord , for which we are all worried! Then how this technique of epidural blood patch is rational? Won’t the epidural blood patch cause the same complications of epidural hematoma?Kindly explain
Just had this done Las night. Felt fine one minute and the next it felt like someone took a baseball bat to me. Got to the hospital and lucky anesthesiologist was still there. As soon as they start the pain immemorial subsided.
Great video, I've had 2 blood patches and I'm still not fixed, still dripping nasaly csf, 7 months still waiting for a second opinion from my old neurologist. Blind blood patches done in hospital. Nightmare.
this case needs to be evaluated for whether the patient needs neurosurgical intervention or not. checking for another differential diagnosis is also essential.
Também fiz 2, e ainda não estou bem totalmente, melhorei uns 30%, faz 4 anos e meio 😭😭😭
Great video thanks.!
Dear Ni An, thank you for your awesome feedback. It means a lot to the NYSORA team. We can't wait to hear from you again next video!
It can happen spontaneously too. Spontaneous Intracranial Hypotension. I can tell you it's not fun trying to get a diagnosis for that!
Hei , The seventh ... true , I found that I have hypotension intracranial one month ago...And I already take 2 blood patch and nothing happens yet. Still have head deck😔
Outstanding sir
Many thanks
Thanks!
Brilliant!
Very informative and helpful 👍🏼👍🏼
Glad it was helpful!
Thank you Dr Hadzic for (as usual) helreat educational video
I want to know if you have personal experience about the effect of
-hydrocortisone
- greater occipital nerve block
Thank you
This is a very nice review. Thank you
Hi Huda! Thanks for watching! Greetings from NYSORA!!
I've had killer orthostatic headaches and tinnitus for almost a year and the doctors only treat me for occipital neuralgia with drugs that don't help one bit. I'll have to try and administer a blood patch to myself.
What do you think about the use of aminophylline in the CPPD?
Have not used aminophyline in quiet some time - so no practical experience with it at this time. Greetings.
How long do you have them lay flat for after the procedure?
To avoid orthostatic hypotension, primarily - 30 minutes. Greetings
Those headaches will PUT YOU DOWN!!! I had 2 blood patches and neither worked. Blugh
Somebody can help me ,I did the blood patch and still I am feeling with the same symptoms
How did it resolve for you?
Buen video.
Me gustaría saber por qué 15 o 20 ML de sangre..yo nunca he pasado de 10 ML.
I had a foraminal block injection of corticosteroids. It’s my 5th infiltration and the only one where I suffered from a terrible headache. The clinic didn’t tell me about blood patches and told me it was unrelated and my personal doctor just blamed my headache on anxiety. I became so anxious that I felt palpitations. I slept almost all day for 7 days , I had a headache for about 15 days. The procedure was a success but now I am scared it will be the same next time. My doctor looked annoyed when I brought back the subject and just gave me another prescription for a future infiltration. By chance , would anybody know if it’s something that happens often with infiltration in L5-S1 ? I fell the result were worth it but I was swearing to never get it again while my head was pounding.
excellent video
but your animations are showing subarachnoid space punctures and injections, as opposed to epidural space
Hi Dr. Hadzic, would it be effective and appropriate, and possibly reduce morbidity, if we administer the blood through an existing epidural catheter that is confirmed to be working (maybe one level above or below where the patient was wet-tapped)?
Are antibiotics recommended before the blood patch?Thank you very much in advance!
Hi Vasilis. As of today - antibiotic prophylaxis is not recommended, and literature on blood patch does not discuss the infection risk, being rare. However, abscess after blood patch has been reported relatively recently, making your question relevant for discussion/consideration. Does anyone else have feedback on this? pubmed.ncbi.nlm.nih.gov/15935637/
What happens if they put more blood and patient didn’t say stop?
Good video
I think one thing you missed id the spinal level of epidural blood patch. It is a level below the level previous neuraxial procedure if i am not wrong. Loss of resistance to saline has its own disadvantage as it is very difficult to differentiate from a wet tap. In case of a wet tap there is serious chance of injecting into Subarachnoid space
Awesome video! My wife had to do a lumbar pucture 4 days ago and she is 15 weeks pregnant, since then she is having headaches every time she stands up or sitting. Not sure if we should wait more or just do the blood patch as well, in fact we are a bit afraid of the blood patch since she is pregnant.
Have her symptoms resolved? Look up hEDS, if she meets the criteria, she may not heal independently. Feel free to ask about anything with this, I'm working my way through it right now. Congratulations on the pregnancy! 😊
@@michellefixitdid it resolve for you?
How is a blind patch done compared to a patch of a leak of known origin?
What is your opinion about sphenopalatine ganglion block for PDPH? Is it a valid attempt to avoid a blood patch?
Hi Kk! Thanks for your question. Regretfully, no experience on our end - but we'd love to kick off a conversation. Anyone out there with feedback? Greetings!
I don't have a personal experience but once I asked Dr Miles Day and he said it is an effective method for PDPH but they mainly use it for cluster headache and they even use an atomizer to deliver and teach the patient ls how to use it
@@nysoravideo Fiz 2 e não resolveu nada, tratamento conservador também não resolveu, somente os blood patch porém temporariamente. Minha dor voltou quando fico sentada ou em pé
@@armindaribeiro3570did you ever get it fixed?
Sir ... Once patch done it is completely recovering pateint or if any chance to repeat problem..?
Please answer sir
Can this help someone who had a T1 - T12 spinal fusion 25 years ago, at the age of 16, and has suffered with severe tinnitus ever since. Any help or advice would be greatly appreciated.
Estou com dores faz 4 anos e meio.
What do you think about having the epidural blood patch through the catheter?
Hi Daniel! Thank you for showing your interest in this topic, For more information, Subscribe to Nysora's Compendium of Regional anesthesia here nysoralms.com/courses/nysora-compendium-of-regional-anesthesia/ and you can have all the information about Epidural blood patch. Greetings!
Don’t forget CRNA’s can also perform a blood patch ;)
Anyone who plays string bass can do miracles! Greetings
Have done many with great results :)
O que é CRNA?
Hi!Any serious complications reported with this?
I have done a lot for PDPH uneventfully.
However,performed one for spontaneous low intracranial pressure headache in a young and fit patient.Tge immediate effect was great.Unfortunately patient passed away unexpectedly about 32 hours later
Descobriu o que houve?
I caught a CNS infection after this procedure, I am lucky to be alive
Has anyone had success with neostigmine and atropine?
What can be used instead of the patient's own blood? The case is of a patient with leukemia.
What am I missing? If there is an ultrasound in the room to draw blood, why wouldn't the clinician use it to see where his needle was in the spine also?
Unnecessary. An experienced anesthesiologist can access the epidural space in 30 seconds or less. Also, you cannot align the ultrasound beam with the needle due to the angle of the procedure.
It is helpful for finding the spinous processes in very obese or scoliotic patients, however.
@@57precision So it is more important to use ultrasound to draw 20cc of blood than to be 100% sure that you are in the epidural space with imaging? Come on man :) Whether fluoro or ultrasound it is the standard of care in the USA at least....we teach the ultrasound method at my course and many organizations like ASIPP or IOF teach fluoro at theirs.... I am simply stating that there is a way to be even safer for the patient.
@@donbufordmd the risk profile is acceptable to me, and I only blood patch after conservative measures have failed. You are certainly welcome to take all post partum mothers down to the fluoro suite if you feel it is necessary.
@@57precision gosh no....only talking about ortho patients lol. We need you for the OB-GYN anesthesia.....
@@57precision But there are some wizards teaching ultrasound guided techniques....and you have it in the room....I think even Nysora has a video on that...lemme look.
I underwent a cervical epidural steroid injection 5 days ago and began experiencing all of the associated symptoms of csf leak 3 days ago. My doctor won't return my calls and I don't want to go to the ER. Statistically, how likely is it that this will resolve on it's own? My headache has subsided to a degree but the dizziness and double vision is still present.
You should definitely go to the ER and keep track of your journey with CSF leaks. Everyone's body is different, so start getting the help you need now.
I'd say go to the ER when this happened to me they did a blood patch and immediately I felt 100% better!!
3:42 Is Wrong information written about summmatriptan .it should be 6 mg SC not 600 mg.
Wow
Add time stamps to your videos
Hi Tay karam! Thanks for the feedback, we will definitely work on it.
I've done thousands of epidurals and only had 2 wet taps. One in residency and the other one because the patient arched her back after loss of resistance. It's almost impossible to get a wet tap using saline and continues pressure, and it takes seconds to place one.
if the yellow ligament is hard... sometimes you use too much strenght in the continues pressure method and go a little too far
@@AkaYuukii the continues pressure is in the syringe, not in the needle. You advance the needle using your left hand slowly.
@@nicolascrescimone oh my instructors have told me to push with the syringe, or maybe I understood wrong... But because of that I feel more confident in switching to intermitent sometimes at the end... it may be wrong. I need to improve, I'm in the first year of residency
With respect, I understand you don’t like to perform EBP but the absence of your reasons was disappointing. Otherwise, another outstanding educational clip in your long career of excellence 👍
Greetings Barry. It's from 4:26 -5. I also spent more time promoting a non-interventional approach than to the actual procedure, which I'd prefer NOT to perform whenever not necessary. As an expert, you end up helping others but also assume the side-effects of the epidural blood patch, which then altogether become your own responsibility. Fortunately, these are typically not severe, but you end up managing them for a few days, which is what it would take for the PDPH to go away with the conservative treatment anyway.
I also dread blood patches and will often opt for conservative treatment whenever possible. I will typically only offer blood patch to patients who have the worst PDPH where it clear they will not tolerate the "wait and see" of conservative care. For me the biggest fear about the blood patch is planning for the sterile blood draw and finding a competent assistant to complete the blood draw while I access the epidural space. This one of those topics that I also review every time it comes up due to the infrequent occurrence in our practice. Great video as always.
@@DRBLUESNYC fala de casos que a cefaléia pós punção não melhora sozinha! Qual o maior tempo relatado? Estou faz 4 anos e meio com esta dor, preciso de ajuda!
epidural anesthesia is NOT supposed to enter the dura. That is not the goal. There is high risk of PDPH (post dural puncture headache) with unintentional puncture of the dura.
The goal of entering the dura would be a SPINAL neuroaxial anesthesia, which may be single shot or continuous spinal
You forget to mention that spinal tape/lumbar punctures also cause CSF leaks!
Mine happened because of lumbar puncture😢
@@za-zi1bc I'm so sorry! Have you tried peptides such as bpc 157, TB1, and KPV ? they can potentially help
This can also happen spontaneously - I experienced a spontaneous CSF leak following heavy lifting, I am due to have my first EBP in a month. Please don’t be fobbed off by your Doctors like I was for years, PUSH FOR HELP!
Any updates?
@@MamaMilkBubbles I have my blood patch next week 🤞🏼
@@shellmcc0414 Fingers crossed for you. I had mine done a few weeks ago, but the headaches came back after a week. Please keep us updated! Best of luck
@@MamaMilkBubbles oh no, do they know what caused your leak? X
@@shellmcc0414 A resident messed up while giving the epidural during labor. I'm not giving up though.
Blood patch should be performed with patient in lateral decubitus
Hi Raul. Respectfully, I do not agree with that statement. Blood patch should be performed in whatever position the operator feels most confident, to decrease the risk of another dural tap. Where expertise is available for epidural in lateral position, I would agree with you - as some patients develop vaso-vagal reaction during the procedure. Afterall, the procedure also takes more time then epidural - and it is more comfortable for the patient. Unfortunately, in my observation, most practitioners feel more competent with the sitting position. Greetings!
Yes…why would you sit a person up who is brought to tears with upright posture….
Are Blood Patches Dangerous?
If somebody tells you they can smell burnt hair and they can taste blood please take the damn needle out!
O que houve?
Epidural blood patches didn’t work for me, in fact I was made worse because of them…. Don’t get an epidural in the first place, either for birthing or ESI for back pain, besides they’re not FDA approved
Thanks!!!
Welcome!