frequent procedures
 

EPIDURAL BLOCK PATCH
Epidural block patch is a procedure done to treat post dural puncture headache. Post dural puncture headache could result from a routine spinal anesthesia procedure that was done for regional block or from an accidental puncture of the thecal sac while performing an epidural steroid injection or an epidural access-related treatment, including epidural catheter placement for control of pain in level. However, the common denominator is that of a puncture of the thecal sac at the level where the spinal canal procedure was attempted or done. Following this, there is a leak of CSF into the epidural space that eventually results in spinal headache that is associated with positional or postural headaches. Such a headache is made worse in an upright position or with ambulation or activity, and relieved by supine position and rest. When conservative management fails with oral hydration, narcotics, and bed rest, or the patient’s headache becomes unbearable, epidural block patch is a readily available alternative approach that provides rapid relief of the headache pain, with the procedure itself causing only minimal discomfort when performed. The procedure is done at the level of the thecal puncture _____, and can be done under fluoroscopy guidance, using an epidural needle to access the level. Blood taken under aseptic conditions is removed from the patient, usually from the cubital fossa, and immediately injected into the epidural space that has already been identified by loss of resistance technique. Such treatment usually produces rapid relief after the patient has had bed rest following injection for about one to two hours while still in the clinic facility. This ensures that there is no return or recurrence of pain. The patients are usually advised to stay supine throughout that period before they are discharged. Patients usually have immediate relief that can be quite dramatic, and they usually leave the clinic free of the headache that has been bothering them for days.

COMPLICATIONS: Infection is a risk because of introduction of a large amount of the patients blood into the epidural space, providing a culture medium. However, epidural block patch is very rarely associated with epidural abscess or infection.

CONTRAINDICATIONS: Patients who have resumed full anticoagulation will have to wait a few days before the procedure can be performed on them, depending on the agent in use.

SEDATIVES: Sedatives are usually not indicated. The procedure is quick and benign, and easily tolerated.
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