The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
권호 표지
DOI QR코드

DOI QR Code

Risk factors associated with repeated epidural blood patches using autologous blood

  • Oh, Ah Ran (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Jungchan (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jeong, Ji Seon (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jin Young (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Ji Won (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Hara (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Sim, Woo Seog (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2021.10.28
  • Accepted : 2022.02.20
  • Published : 2022.04.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: An epidural blood patch (EBP) is a procedure to treat intracranial hypotension that does not respond to conservative treatment. EBPs are commonly repeated when the symptoms persist. In this study, we used a large single-center retrospective cohort and evaluated the factors associated with repeated EBPs. Methods: From January 2010 to December 2020, a total of 596 patients were treated with EBPs for intracranial hypotension. We evaluated the factors associated with repeated EBPs in the entire population, in patients with spontaneous intracranial hypotension (SIH), and in those with available myelographies. Results: In a total of 596 patients, 125 (21.1%) patients required repeated EBPs, and 96/278 (34.5%) in SIH and 29/314 (9.2%) in iatrogenic population. In patients with SIH, international normalized ratio (INR) and cerebrospinal fluid (CSF) leakage on myelographies consistently exhibited significant associations (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.02-1.87; P = 0.043 and OR, 2.18; 95% CI, 1.28-3.69; P = 0.004). In patients with iatrogenic injury, INR and CSF leakage on myelogram did not show difference in repeated EBPs. Conclusions: Repeated EBPs may be more frequently required in patients with SIH. Prolonged INR and CSF leakage were associated with repeated EBPs in patient with SIH. Further studies are needed to determine factors associated with repeated EBP requirements.

Keywords

References

  1. Davidson B, Nassiri F, Mansouri A, Badhiwala JH, Witiw CD, Shamji MF, et al. Spontaneous intracranial hypotension: a review and introduction of an algorithm for management. World Neurosurg 2017; 101: 343-9. https://doi.org/10.1016/j.wneu.2017.01.123
  2. Ducros A, Biousse V. Headache arising from idiopathic changes in CSF pressure. Lancet Neurol 2015; 14: 655-68. https://doi.org/10.1016/S1474-4422(15)00015-0
  3. Lee C, Song JG, Park JH, Shin JW, Choi Y, Yun CS. Epidural blood patch to treat spontaneous intracranial hypotension. J Korean Pain Soc 2000; 13: 79-83.
  4. Rettenmaier LA, Park BJ, Holland MT, Hamade YJ, Garg S, Rastogi R, et al. Value of targeted epidural blood patch and management of subdural hematoma in spontaneous intracranial hypotension: case report and review of the literature. World Neurosurg 2017; 97: 27-38. https://doi.org/10.1016/j.wneu.2016.09.076
  5. Pattichis AA, Slee M. CSF hypotension: a review of its manifestations, investigation and management. J Clin Neurosci 2016; 34: 39-43. https://doi.org/10.1016/j.jocn.2016.07.002
  6. Kawaguchi M, Hashizume K, Watanabe K, Inoue S, Furuya H. Fluoroscopically guided epidural blood patch in patients with postdural puncture headache after spinal and epidural anesthesia. J Anesth 2011; 25: 450-3. https://doi.org/10.1007/s00540-011-1135-2
  7. Sencakova D, Mokri B, McClelland RL. The efficacy of epidural blood patch in spontaneous CSF leaks. Neurology 2001; 57: 1921-3. https://doi.org/10.1212/WNL.57.10.1921
  8. Levi V, Di Laurenzio NE, Franzini A, Tramacere I, Erbetta A, Chiapparini L, et al. Lumbar epidural blood patch: effectiveness on orthostatic headache and MRI predictive factors in 101 consecutive patients affected by spontaneous intracranial hypotension. J Neurosurg 2019; 132: 809-17. https://doi.org/10.3171/2018.10.jns181597
  9. Park JY, Ro YJ, Leem JG, Shin JW, Oh Y, Choi SS. Predictors associated with outcomes of epidural blood patch in patients with spontaneous intracranial hypotension. J Clin Med 2021; 10: 922. https://doi.org/10.3390/jcm10050922
  10. Boonmak P, Boonmak S. Epidural blood patching for preventing and treating post-dural puncture headache. Cochrane Database Syst Rev 2010; 1: CD001791.
  11. Schievink WI. Misdiagnosis of spontaneous intracranial hypotension. Arch Neurol 2003; 60: 1713-8. https://doi.org/10.1001/archneur.60.12.1713
  12. Schievink WI, Maya MM, Moser F, Tourje J, Torbati S. Frequency of spontaneous intracranial hypotension in the emergency department. J Headache Pain 2007; 8: 325-8. https://doi.org/10.1007/s10194-007-0421-8
  13. Amoozegar F, Guglielmin D, Hu W, Chan D, Becker WJ. Spontaneous intracranial hypotension: recommendations for management. Can J Neurol Sci 2013; 40: 144-57. https://doi.org/10.1017/s0317167100013664
  14. Shikdar S, Vashisht R, Bhattacharya PT. International normalized ratio (INR) [Internet]. Treasure Island: StatPearls Publishing; 2021. Available at: https://www.ncbi.nlm.nih.gov/books/NBK507707/.
  15. Cho KI, Moon HS, Jeon HJ, Park K, Kong DS. Spontaneous intracranial hypotension: efficacy of radiologic targeting vs blind blood patch. Neurology 2011; 76: 1139-44. https://doi.org/10.1212/WNL.0b013e318212ab43
  16. Dommisse GF. The blood supply of the spinal cord. A critical vascular zone in spinal surgery. J Bone Joint Surg Br 1974; 56: 225-35. https://doi.org/10.1302/0301-620X.56B2.225