Epidural blood patch.

(PDPH) by epidural blood patch (EBP) was first dein distinguishing PDPH from a headache from other scribed by Gormley in 1960 [1]. He injected 2–3 mL of causes. It is performed thus. While the headache is autologous blood in seven patients (one of whom present, firm continuous abdominal pressure is apwas himself suffering from PDPH after a myelogram) plied with a hand on the abdomen and the back. If the producing complete relief of headache within 30 min. headache improves (it often dramatically disappears), The technique was subsequently popularized in the usually within 30 s, and then rapidly returns on release, early 1970s by the publication of large numbers of it is characteristic of a PDPH. Headaches from other successes in a series of 108 patients by Digiovanni et causes are little affected by this manoeuvre. al. [2,3]. Although now a well-accepted technique, it Without treatment, PDPH persists for several days [4, is worth reviewing the indications, limitations and 6] and, on rare occasions, for weeks or even complications. months [7–9]. The group of patients most frequently There is no doubt that PDPH can be (and often is) focused on are those in obstetrics. Because the sympa very distressing and debilitating symptom. Before toms are debilitating at a time when the new mother considering EBP, a firm diagnosis needs to be made. (who does not have another illness, unlike patients A careful history is the first step. Has the patient had who need a diagnostic lumbar puncture) has no wish a procedure done that could have resulted in breach to be recumbent in bed, early diagnosis and treatment of the dura? This is straightforward when the patient are imperative. There is usually no real difficulty in has received spinal anaesthesia or a known dural tap following up those patients who are known to have after epidural anaesthesia, which has been adhad the dura breached, either by recognized inministered in the previous 24–48 h. Although not aladvertent dural tap or by the use of spinal anaesthesia. ways thought of by physicians or orthopaedic With the increased tendency for early discharge from surgeons, it can of course follow diagnostic lumbar hospital, this may require either follow-up by telepuncture and lumbar sympathetic block. phone or informing the patient to contact the hospital History of the headache itself is helpful. PDPH is anaesthetic department in the event of a headache. typically exacerbated by assuming the upright position