Epidural blood patches are effective for postdural puncture headache in pediatrics – a 10-year experience

Authors

  • Merja Kokki,

    1. Department of Anesthesia and Operative Services, Kuopio University Hospital, Kuopio, Finland
    2. Department of Anesthesiology and Intensive Care, School of Medicine, University of Eastern Finland, Kuopio, Finland
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    • These authors contributed equally to this work.
  • Sari Sjövall,

    1. Department of Anesthesia, Satakunta Central Hospital, Pori, Finland
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    • These authors contributed equally to this work.
  • Hannu Kokki

    Corresponding author
    1. Department of Anesthesiology and Intensive Care, School of Medicine, University of Eastern Finland, Kuopio, Finland
    • Department of Anesthesia and Operative Services, Kuopio University Hospital, Kuopio, Finland
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Correspondence

Hannu Kokki, Professor, Department of Anesthesia and Operative Services, Kuopio University Hospital, PO Box 1777, FI-70211 Kuopio, Finland

Email: hannu.kokki@kuh.fi

Summary

Background

Postdural puncture headache (PDPH) is a relatively common complication after lumbar punctures (LP). If conservative treatment is not sufficient within a few days and the symptoms are severe, an epidural blood patch (EBP) may be performed.

Aim

A chart review to evaluate the need and effectiveness of EBPs in children and adolescents over a 10-year period at Kuopio University Hospital (KUH) and Satakunta Central Hospital (SCH).

Methods

The information system patient measures databases were reviewed to identify patients who had received an EBP. Then, the pediatric patients' medical records were compared to the characteristics of the PDPH and associated symptoms and were evaluated for the effectiveness of EBPs.

Results

Forty-two EBPs were performed in 41 patients (24 girls, 17 boys), 26 at KUH and 15 at SCH. Five patients, all at KUH, were children aged 3–12 years, and 36 patients were adolescents, aged 13–18 years. The indications for LPs were diagnostic (n = 26), spinal anesthesia/analgesia (n = 11), or introduction of chemotherapy (n = 2), and four patients developed PDPH after an inadvertent dural puncture with an epidural needle. The first EBP provided a complete relief of symptoms in 37 children, an initial success rate of 90%, and permanent relief in 85%. At KUH, the need for EBPs after spinal anesthesia/analgesia was <1/1000 in children and 2–3/1000 in adolescents, and that after chemotherapy 1–2/1000. No serious adverse effects related to EBPs were recorded.

Conclusion

If PDPH symptoms are severe and are not relieved with conservative treatment, EBP is a highly effective procedure in pediatric patients.

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