Postdural puncture headache and epidural blood patch use in elderly patients

Postdural puncture headache is a known complication after lumbar puncture. In elderly patients, postdural puncture headache necessitating epidural blood patch is considered rare. The literature assessing the use and safety of epidural blood patch in the elderly is sparse; therefore, in the present study, the use and efficacy of epidural blood patch in patients 65 years or older was evaluated.

Retrospective study.

Two tertiary and one secondary hospital in Finland.

The Information System Patient Measures Databases were interrogated to identify patients 65 years or older in whom epidural blood patch was performed between 2000 and 2011.

The patients' medical records were reviewed for the patient demographics, details of lumbar puncture, postdural puncture headache and other symptoms, conservative treatment, and efficacy and complications of epidural blood patch procedure.

A total of 40 patients had epidural blood patch. Their age varied between 65 and 82 years, and 17 were men. The indications for lumbar puncture were as follows: diagnostic (n = 15), therapeutic (n = 1), spinal anesthesia (n = 15), epidural anesthesia/analgesia (n = 5), and combined spinal-epidural anesthesia (n = 4). Most epidural blood patches were performed between 3 and 5 days (1-20 days) after lumbar puncture. In 34 (85%) patients, epidural blood patch provided a complete and persistent relief of symptoms. In 2 patients, the outcome data were not available, and in 4 patients, symptoms were slightly (n = 3) or not (n = 1) relieved with epidural blood patch. Conservative treatment was then provided.

The elderly may also develop postdural puncture headache, and epidural blood patch is an effective and well-tolerated treatment of persistent and severe symptoms.