An epidural blood patch is a procedure to treat a persistent cerebrospinal fluid (CSF) leak causing a post-dural puncture headache — a severe headache that is worse when sitting or standing and improves when lying flat.
A small volume (15–25 ml) of the patient's own blood is drawn from a vein in the arm under sterile conditions. Using the same technique as an epidural injection, a needle is inserted into the epidural space near the site of the dural puncture. The autologous blood is slowly injected into the epidural space, where it clots and seals the CSF leak. The procedure takes 15–20 minutes.
An epidural blood patch is recommended for post-dural puncture headache (PDPH) that has not resolved with conservative measures (bed rest, hydration, caffeine, analgesics) within 24–48 hours. PDPH occurs after epidural anaesthesia, spinal anaesthesia, lumbar puncture, or inadvertent dural puncture during spinal surgery.
Conservative treatment: bed rest in a flat position, oral and IV hydration, caffeine (oral or IV), analgesics, and abdominal binders. Most mild PDPHs resolve within a few days to a week with conservative measures.
Clinical diagnosis of PDPH (postural headache). No imaging usually needed. Standard blood tests to confirm suitability. The procedure can be performed at the bedside or in theatre.
Immediate or rapid relief of the headache in approximately 85–95% of patients. The blood clot seals the dural hole and prevents further CSF leakage. A second blood patch may be needed if the headache recurs.
Transient back ache at the injection site is common for a few days.
Brief increase in headache or back pressure during injection.
Approximately 10–15% of patients need a second blood patch.
Epidural abscess or meningitis. Very rare with sterile technique.
Temporary radiculopathy from blood tracking along nerve roots.
Very rare.
Extremely rare inflammatory response.
Local anaesthetic at the needle insertion site. Performed by an anaesthetist with epidural expertise.
Lie flat for one to two hours after the procedure. Avoid straining, heavy lifting, and Valsalva manoeuvre for 48 hours. Increase fluids. Most patients experience relief within hours. Return to normal activities within 24–48 hours.
Review at 24–48 hours. Second blood patch at 24–48 hours if headache recurs.
Most patients experience significant relief within minutes to hours. Some experience gradual improvement over 24–48 hours.
A second blood patch can be performed if the headache recurs. The success rate of a second patch is approximately 90–95%.
Dural puncture can occur intentionally (spinal anaesthesia, lumbar puncture) or accidentally (during epidural anaesthesia or spinal surgery). The resulting hole allows CSF to leak, reducing pressure around the brain and causing the headache.