Prior to Epidural Blood Patch:
FIRST 24 HOURS:
- Encourage PO fluid intake.
- Supine position
- Oral analgesics (NSAIDS / opioids)
SECOND 24 HOURS:
- Caffeine 500mg in 1L LR over 4 hours.
- Aminophylline 100 mg po BID.
THIRD 24 HOURS:
- consult anesthesiology or interventional radiology for possible epidural blood patch
Schematic section through the vertebral column, showing the cauda equina and its covering membranes with the dural leakage site before (A) and after (B) application of the epidural blood patch.
Post-blood patch orders:
- supine x2 hours
- no strenuous exercises x 3 weeks
- Watch out for:
- sciatica / immediate exacerbation of symptoms and radicular pain – PRN pain meds
- bowel and bladder dysfunction
- intracranial hypertension
If blood patch not an option: oral or IV caffeine 300-500mg OD or BID (therapeutic doses have been associated with CNS toxicity and atrial fibrillation
“Brain Sag”. Peripheral Brain. N.p., 2016. Web. 24 June 2016.
R Oedit et al. Efficacy of the epidural blood patch for the treatment of post lumbar puncture headache BLOPP: A randomised, observer-blind, controlled clinical trial. BMC Neurology 20055:12 DOI: 10.1186/1471-2377-5-12.