Epidural Blood Patch

What is an epidural blood patch?

An epidural blood patch (EBP) is a procedure in which a healthcare provider injects a small amount of your blood into the epidural space near your spinal cord to stop a cerebrospinal fluid (CSF) leak.

Providers offer this procedure to help treat spinal headaches (post-dural puncture headaches). An EBP has two functions:

• It seals the puncture site or tear by forming a temporary blood clot.
• It reduces low CSF pressure.

Epidural blood patch procedures are often successful at treating a spinal headache, but they don’t work in some cases. An EBP is an elective procedure, which means it’s optional.

When would I need an epidural blood patch?

Your healthcare provider may recommend an EBP if you develop a spinal headache and conservative treatment doesn’t help. This includes:

• Bed rest.
• Staying hydrated with IV fluids and/or drinking water.
• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• IV or oral caffeine.

You may also want an EBP if you can’t rest for prolonged periods — like if you just had a baby or need to go back to work.

A spinal headache can develop after:

• A spinal tap (lumbar puncture).
• An epidural for anesthesia (numbness) or analgesia (pain relief).
• A dural tear from a spinal surgery or injury.

Pain from spinal headaches is often intense. It typically increases when you sit or stand and gets better when you lie down.

Your provider may also recommend an EBP if you have spontaneous (sudden) intracranial hypotension due to dural tears from connective tissue diseases. Intracranial hypotension is decreased cerebrospinal fluid pressure around your brain. It causes a headache and other symptoms.

How do I prepare for an epidural blood patch procedure?

Your healthcare provider will explain the steps of the procedure and tell you about the possible risks. To prepare, you may need to not eat or drink anything for at least eight hours before the procedure. It’s important to tell your provider if you:

• Take blood thinners (anticoagulants).
• Have diabetes and take insulin.
• Have any allergies, especially to anesthesia drugs.
• Are pregnant.

What happens during an epidural blood patch procedure?

The steps of an epidural blood patch procedure include:

• You’ll lie on your side or be in a seated position. You’ll need to be very still during the procedure.
• A healthcare provider will disinfect the area of your spine where they’ll inject the blood patch — near where the original puncture happened. They’ll also disinfect the area where they’ll draw a sample of your blood — usually your forearm or wrist.
• You may receive a local anesthetic near where the blood patch will go to numb the area and minimize pain. This may be a patch or an injection.
• A provider will insert an IV catheter with a needle into one of your blood vessels to be able to get a sample of your blood.
• An anesthesiologist or radiologist will insert a needle into the epidural space near your spinal cord. They may use imaging guidance, like ultrasound, to locate the exact spot.
• Right after this, a provider will collect a sample of your blood through the IV catheter.
• The provider will slowly inject the blood into your epidural space over 30 to 60 seconds. You’ll likely feel discomfort or cramping in the area as this happens. Let the anesthesiologist know what you’re feeling.
• After the injection, a provider will cover the area with a bandage.

What happens after an epidural blood patch procedure?

Most people feel immediate headache relief after getting an epidural blood patch. A healthcare provider will take you to a recovery room to let you rest before you can go home. Your provider will likely tell you to avoid strenuous activity for 24 hours. After that, you can go back to your usual activities.

Are you sedated for a blood patch?

Healthcare providers typically don’t use sedation (deep relaxation) for adults for an epidural blood patch. This is because you need to be able to tell the anesthesiologist what you’re feeling as they inject the blood. Providers do often provide local anesthesia to minimize the pain or discomfort you may feel during the initial needle injection. If you’re nervous or anxious about the procedure, be sure to let your provider know.

Children who need an epidural blood patch may receive sedation for part of the procedure.

What are the benefits of an epidural blood patch procedure?

EBPs usually provide immediate — and prolonged — spinal headache relief, whereas conservative treatments, like NSAIDs and caffeine, are typically temporary. Spinal headaches can last up to two weeks, so EBPs can offer quicker relief.

What is the success rate of a blood patch?

Studies show that epidural blood patches have a success rate of about 85%. That means about 85 out of 100 procedures result in spinal headache relief.

What are the side effects and possible complications of an epidural blood patch?

The most common side effects of an EBP are pain or discomfort around the injection site after the procedure. This usually improves within days of the procedure.

Possible complications include:

• Failure of the EBP (it doesn’t treat your spinal headache).
• Worsening of your spinal headache due to accidental dural damage.
• Infection.

Can a spinal headache come back after a blood patch?

Yes. Epidural blood patch procedures aren’t always successful. You may still have a spinal headache despite undergoing the procedure. But this is uncommon. A second procedure treats the headache in 90% of these cases.

When should I call my healthcare provider?

Call your healthcare provider immediately if you develop signs of an infection after your epidural blood patch procedure. Signs include:

• Skin discoloration, pain and/or pus around the injection site.
• Fever.
• Fatigue.

How long does an epidural blood patch stay on?

You won’t be able to see the epidural blood patch because it’s inside you in the epidural space near your spinal cord. The blood patch (clot) will dissolve over time — usually over days or weeks.

A note from Cleveland Clinic

When you have a throbbing spinal headache that only gets better when you’re lying down, you’ll probably want quick relief. An epidural blood patch may be able to offer that. Be sure to discuss the risks and benefits of an EBP with a healthcare provider before deciding to get one — and know that the patches aren’t always successful. A provider will be there to address any questions or concerns you may have.