Epidural blood patch (EBP) is a well-established procedure for treatment of cerebrospinal fluid (CSF) leaks arising from the spinal column. This procedure uses autologous blood (the patient’s own blood) injected into the epidural space.
The spinal cord is enclosed within a sac of CSF which is contained by a membranous layer called the dural sac. The epidural space is the space between this dural sac and the bony vertebral column. The blood injected is thought to clot and therefore effectively ‘patch’ the hole in the dura.
EBP procedure is routinely used to relieve post dural puncture headache caused by epidural complications, but it is important to note that a CSF leak can have other causes.For example, spontaneous (no precipitating event) or traumatic (fall or whiplash injury) causes.
The tear / hole in the dura can cause CSF to leak out which can lower CSF pressure, resulting in postural headaches (worsening with upright posture and relieved upon lying down), neck pain and other neurological symptoms. Widespread pain and inflammation is also possible. CSF leaks are sometimes difficult to diagnose as symptoms may vary between patients, hence, your response to an EBP can also be used to confirm the diagnosis.
EBP is performed under sterile conditions in an operating theatre using mild sedation. Fluoroscopic X-ray guidance allows the operator to accurately position an epidural needle. A doctor will access a vein via a cannula in the arm for drawing your blood to use and keep it sterile. Your treating doctor will then gradually inject a variable amount of blood into the epidural space. You may be asked to feedback during the procedure regarding pressure levels / response.
EBP is typically done lying on your stomach. Your blood pressure and oxygen rates will be monitored
You will be taken to the recovery room for a few hours where you will lie flat and still and pain levels, BP and vital signs will be monitored.
Your treating doctor will discuss lying and resting on your back for 4-6 hours post procedure. If you do need to go to the toilet, please use the log rolling technique ( see below )
Preferably, you will be kept in hospital overnight. You will need to be driven home by a carer post EBP procedure.
When you get home, it is advised to lie down, rest and take it easy for the next 24-48 hours. The following day you can resume light activity. Return to work may take a bit longer, depending on your individual circumstances and previous level of function.
Diet: Maintain fluids with electrolytes. Avoid foods high in vitamin A (i.e. sweet potato), limit salt and avoid caffeine intake as these substances can increase pressure if you have mild rebound high pressure.
Rebound Intracranial hypertension or rebound high pressure (RHP) only occurs in roughly 33% of cases5, but is more likely in chronic, long term CSF leaks. Symptoms include a severe pressure headache in your forehead or behind the eyes, tinnitus (ringing or pulsing in the ears) and increased head pain when lying down, i.e. a change in headache pattern
Note: If you do have rebound high pressure symptoms, treatment may include simple lifestyle and diet advice or certain medications may be advised – please discuss this with your treating doctor.
If you have increasing pain after 24 hours, signs of infection (i.e. fever or chills), new onset limb weakness, numbness, trouble emptying bladder and / or bowels, a stiff neck, photophobia (aversion to bright light) or severe headache. Increased or severe head pressure behind the eyes which is worsened with lying down.
Please note the contents contained in this Patient Fact Sheet are not intended as a substitute for your own independent health professional’s advice, diagnosis or treatment. At Metro Pain Group, we assess every patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative, and evidence-based treatments tailored to suit each patient. As such, recommended treatments and their outcomes will vary from patient to patient. If you would like to find out whether our treatments are suitable for your specific condition, please speak to one of our doctors at the time of your consultation.