The role of epidural blood patching in the prevention or treatment of the headache that may follow dural puncture (usually lumbar puncture) is inconclusive. Dural puncture involves passing a needle into the fluid-filled space around the spinal cord and nerve roots. This procedure is used to obtain spinal fluid for laboratory tests or to give a spinal anaesthetic. However, leakage of fluid through the puncture created by the needle can cause headache. One suggestion for preventing or treating this headache is to inject some of the patient's own blood around the puncture to stop the leakage (epidural blood patch). However, this review showed that, according to current evidence, clear conclusions cannot be drawn about the advantage of preventative epidural blood patch over other treatments. The use of epidural blood patch after the onset of the headache, however, showed benefit over conservative treatment. There were too few participants in the included studies, however, to allow a reliable assessment of the potential benefits and harms of this technique.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 7, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Boonmak P, Boonmak S. Epidural blood patching for preventing and treating post-dural puncture headache. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD001791. DOI: 10.1002/14651858.CD001791.pub2

Editorial Group: Pain, Palliative and Supportive Care Group

This version first published online: April 22. 2002
Last assessed as up-to-date: April 1. 2009

Abstract

Background

This is an update of a Cochrane Review first published in Issue 2, 2002. Dural puncture is a common procedure, but leakage of cerebrospinal fluid (CSF) from the resulting dural defect may cause post-dural puncture headache (PDPH) after the procedure, and this can be disabling. Injecting an epidural blood patch around the site of the defect may stop this leakage.

Objectives

To assess the possible benefits and harms of epidural blood patching in both prevention and treatment of PDPH.

Search strategy

We searched the Cochrane PaPaS Group Trials Register; CENTRAL; MEDLINE and EMBASE in April 2009.

Selection criteria

We sought all randomised controlled trials (RCTs) that compared epidural blood patch versus no epidural blood patch in the prevention or treatment of PDPH among all types of participants undergoing dural puncture for any reason. The primary outcome of effectiveness was postural headache.

Data collection and analysis

One review author extracted details of trial methodology and outcome data from studies considered eligible for inclusion. We invited authors of all such studies to provide any details that were unavailable in the published reports. We performed intention-to-treat (ITT) analyses using the Peto O-E method. We also extracted information about adverse effects (post-dural puncture backache and epidural infection).

Main results

Nine studies (379 participants) were eligible for inclusion. Prophylactic epidural blood patch improved PDPH compared to no treatment (OR 0.11, 95% CI 0.02 to 0.64, one study), conservative treatment (OR 0.06, 95% CI 0.03 to 0.14, two studies) and epidural saline patch (OR 0.16, 95% CI 0.04 to 0.55, one study). However, prophylactic epidural blood patch did not result in less PDPH than a sham procedure (one study). Therapeutic epidural blood patch resulted in less PDPH than conservative treatment (OR 0.18, 95% CI 0.04 to 0.76, one study) and a sham procedure (OR 0.04, 95% CI 0.00 to 0.39, one study). Backache was more common with epidural blood patch. However, these studies had very small numbers of participants and outcome events, as well as uncertainties about trial methodology, which preclude reliable assessments of the potential benefits and harms of the intervention.

Authors' conclusions

The review authors do not recommend prophylactic epidural blood patch over other treatments because there are too few trial participants to allow reliable conclusions to be drawn. However, therapeutic epidural blood patch showed a benefit over conservative treatment, based on the limited available evidence.

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