In this study adverse effects were not mentioned, which prevents firm conclusions. One other study compared prophylactic EDBP versus no blood patch among obstetric patients and reported a high success rate. One of these studies was not blinded, three were not randomised, one was only reported as an abstract. Seven controlled trials concerning prophylactic treatment have been published. Many observational studies followed they reported success rates of the EDBP for PDPH between 70% and 90%. All 6 subjects were relieved of their complaints. He therefore continued to treat 6 subjects suffering from PDPH with EDBP, locating the epidural space with the hanging-drop or loss of resistance method. He theorised that the epidural bleeding might lead to clot formation over the dural rent, preventing CSF leakage into the epidural space. He noticed that inadvertent bloody spinal taps were less often complicated by PDPH. Gormly introduced this technique in the 1960's. It involves the injection of 10–20 ml of autologous blood into the epidural space around the site of the spinal tap. ![]() EDBP has gained popularity as a therapeutic measure for PDPH. If, despite the prophylactic measures, PDPH occurs, epidural blood patch (EDBP) may be a beneficial therapeutic intervention. Obviously this has financial, social and psychological repercussions.ĭifferent prophylactic measures such as: small needle size, the use of Sprotte's needle, reinsertion of the stylet before withdrawing the needle, and direction of the brevel perpendicular to the dura, have all been shown to reduce the occurrence of PDPH. During an episode of PDPH the patient may be completely incapacitated and confined to bed. In a small minority of cases, the symptoms may persist for weeks or even months. They generally resolve within 7 days or less, in 80% of the cases. ![]() PDPH and accompanying symptoms are self-limiting. ![]() PDPH may occur immediately after spinal tap, but it starts within 48 hours after the procedure in more than 90% of the patients. Besides of headache, the patient may complain of diplopia, tinnitus, dizziness, and myalgia. The leakage causes a decrease in CSF pressure and volume, leading to traction on pain-sensitive structures in an upright position. PDPH is probably caused by cerebral spinal fluid leakage through the dural rent, into the epidural space. This postdural puncture headache (PDPH) is typically orthostatic provoked or aggravated by a vertical or upright position and relieved by a horizontal position. Headache complicates approximately 10 to 40% of dural punctures.
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