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Epidural blood patch in a seven-year-old child
1Department of Anaesthesia, Hôpital Sainte-Justine, Montréal, Canada.
Insights
A child developed a severe headache after an epidural block, diagnosed as postdural puncture headache (PDPH). An epidural blood patch (EBP) effectively resolved the symptoms, showing its utility in pediatric cases.
Area of Science:
- Pediatric Anesthesiology
- Neurology
- Pain Management
Background:
- Epidural anesthesia is increasingly used for pediatric pain management.
- Postdural puncture headache (PDPH) is a potential complication.
- Unintentional dural puncture can occur during epidural procedures.
Observation:
- A 7-year-old girl experienced severe headache, neck pain, and positional relief after a urological procedure with epidural analgesia.
- Symptoms were consistent with PDPH, despite no clear evidence of dural puncture during the procedure.
- Standard oral analgesics were ineffective.
Findings:
- Diagnosis of postdural puncture headache (PDPH) was confirmed by independent specialists.
- An epidural blood patch (EBP) using autologous blood was performed.
- The EBP led to complete resolution of the patient's headache and neck pain.
Implications:
- This case highlights the potential for PDPH in children following epidural procedures.
- Epidural blood patches, though rarely reported in pediatric patients, are an effective treatment for PDPH.
- Increased use of pediatric epidurals may necessitate greater awareness and application of EBP techniques.
Abstract:
We present an unusual case of postoperative headache in a child after an epidural block. A seven-year-old girl (ASA 1) was scheduled to undergo a urological procedure under general anaesthesia combined with an epidural technique for intra- and postoperative analgesia. Although there was no evidence of dural puncture when the block was performed, the patient developed a headache postoperatively. The headache, which was accompanied by neck pain, appeared in the sitting or standing position and was relieved by decubitus. According to the mother, her child had never complained of those symptoms in the past. After independent evaluation by an anaesthetist and a neurologist, a postdural puncture headache (PDPH) was considered the most likely diagnosis. As oral analgesics failed to provide relief, and epidural blood patch (EBP) using 10 ml autologous blood was performed under light sedation. This was followed by resolution of the symptoms. Epidural injections of opioids and local anaesthetics are becoming increasingly popular for pain management in children. This implies that there may be an increasing number of unintentional dural punctures that may result in more PDPHs in children. Epidural blood patches are effective in treating PDPHs in adults but their use has been reported very rarely in children. Resolution of the patient's symptoms following EBP supported the diagnosis while illustrating that EBP can be useful in the treatment of PDPH in children.