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Updated: Aug 14, 2025

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A Single-Level Epidural Blood Patch for Multiple Cerebrospinal Fluid Leaks: How it Works

Amlan Swain1, Seelora Sahu1, Rashmi Kumari1

  • 1Department of Anaesthesiology, Tata Main Hospital, Jamshedpur, Jharkhand, India.

Anesthesia, Essays and Researches
|January 9, 2023
PubMed
Summary

Spontaneous intracranial hypotension from cerebrospinal fluid (CSF) leaks can cause severe headaches. A single lumbar epidural blood patch successfully treated a patient with multiple spinal CSF leaks and intracranial hemorrhage.

Keywords:
Cerebrospinal fluid leakepidural blood patchspontaneous intracranial hypotension

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
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