Epidural Blood Patch to Treat a Postsurgical Cerebrospinal Fluid Leak Using Central Line Kit

Abstract

Epidural blood patches are considered definitive treatment for postdural puncture headache in adult patients. However, they are infrequently used in children or in patients with altered spine anatomy. In patients who have undergone recent spine surgery, the lumbar epidural space can be approached safely via the caudal canal. Our case demonstrates a novel technique to perform an epidural blood patch from a caudal approach using a commonly available central line kit for a 15-year-old patient with severe spinal headache due to cerebrospinal fluid leak following a hemilaminectomy.

Lay abstract

An epidural blood patch is an injection of the patient’s own blood into their back in the epidural space, which is the definitive treatment for headaches as a result of spinal fluid leakage. However, they are infrequently used and difficult to perform in children or in patients who have had prior back surgeries. In patients who have undergone recent spine surgery, their back-epidural space can be approached safely through caudal canal near the tailbone. Our case demonstrates a novel technique to perform an epidural blood patch from a caudal approach using a commonly available central line kit in a 15-year-old patient with severe spinal headache due to cerebrospinal fluid leak after a back surgery.

Keywords::

• acute pain
• epidural blood patch
• equipment
• postdural puncture headache
• regional anesthesia

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Informed consent disclosure

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved. The authors state that they have obtained verbal and written informed consent from the patient/patients for the inclusion of their medical and treatment history within this case report. Health Insurance Portability and Accountability Act (HIPAA) authorization was also obtained from the patient and legal guardian for the publication of this case.