///2011 Abstract Details
2011 Abstract Details2018-05-01T17:54:20+00:00

The evolution of epidural blood patch for the treatment of post-dural puncture headache

Abstract Number: 79
Abstract Type: Other

Anna Rosenfeld MD, MPH1

Lumbar puncture, introduced into clinical practice in 1891, resulted in the first documented case of post-dural puncture headache (PDPH) by 1898,(1,2) and it was soon postulated that CSF leak was in some way responsible. By 1918, MacRobert proposed that the rigid dural membrane, unable to close immediately upon withdrawl of the spinal needle, enables CSF to slowly continue leaking into the epidural space until complete healing, over the course of approximately seven to eight days, allows for the resolution of headache.(3)

Once a plausible mechanism for PDPH had been outlined, attempts were made to minimize its incidence. In 1922, Hoyt presented a needle within needle technique – a precursor to the modern CSE. He described the identification of the space outside the dural sac with a larger needle by noting changes in resistance of the tissue followed by puncture of the dura with a smaller needle.(4) In 1949, Greene referenced Hoyt’s work and described a similar technique using a shorter 21 gauge introducer needle for his 26 gauge spinal needle. He also pointed out the special significance the problem of PDPH played in the obstetric population where “blood loss and dehydration are more marked and less treated among postpartum patients than among routine surgical cases” making this problem “more common and severe”.(5)

While work was being done to lessen the occurrence of PDPH, research was also underway to find a treatment. Attempts to seal the hole in the dura using catgut and gum acacia were described but were suboptimal.(6,7) In 1960, Gromley published his observation that the incidence of PDPH appeared lower after a bloody tap. He postulated that the blood produced a seal or patch for the hole in the dura and presented a small case series describing the performance of a new procedure, the epidural blood patch (EBP).(8) DiGiovanni expanded on this work, publishing data on the technique, efficacy, and safety of this procedure.(9,10) Largely because of the work done by Gromley and DiGiovanni, the leadership of SOAP undertook the first prospective study of EBP in the obstetric population. Their 1974 publication confirmed the safety and efficacy of EBP, firmly establishing its role within the realm of the obstetric anesthesia practice.(2)

References:

1. Br M J 1934;2:349

2. Anesthesiology 1974;41:307-8

3. JAMA 1918;40:1350-3

4. JAMA 1922;78:428-9

5. Anesthesiology 1950;11:464-9

6. Arch Derm Syph 1930;21:615-27

7. Acta Chirug Scan 1947;95:1-272

8. Anesthesiology 1960;21:565-6

9. Anes & Analg 1970;49:268-71

10. Anes & Analg 1972;51:226-32

SOAP 2011