Effective epidural blood patch volumes for postdural puncture headache in Taiwanese women

Epidural blood patch (EDBP) is the most commonly used method to treat postdural puncture headache (PDPH). The optimal or effective blood volume for epidural injection is still controversial and under debated. This study compared the therapeutic efficacy of 7.5 mL blood vs. 15 mL blood for EDBP via epidural catheter injection.

Thirty-three patients who suffered from severe PDPH due to accidental dural puncture during epidural anesthesia for cesarean section or epidural analgesia for labor pain control were randomly allocated into two groups. EDBP was conducted and autologous blood 7.5 mL or 15 mL was injected via an epidural catheter in the semi-sitting position in Group I (n = 17) and II (n = 16), respectively. For all patients in both groups, the severity of PDPH was registered on a 4-point scale (none, mild, moderate, severe) and assessed 1 hour, 24 hours and 3 days after EDBP.

There was no significant difference between the two groups of patients at all time points with respect to the severity of PDPH. Two patients in Group I and nine in Group II developed nerve root irritating pain during blood injection (p < 0.05). No systemic complications were noted in both groups of patients throughout EDBP injection.

We conclude that injection of 7.5 mL autologous blood into the epidural space is comparable to 15 mL blood in its analgesic effect on PDPH, but with less nerve root irritating pain during injection.