62273 Injection, epidural, of blood or clot patch

Name of the Procedure:

Epidural Blood Patch
Technical Term: Injection, epidural, of blood or clot patch

Summary

An epidural blood patch involves injecting a small amount of the patient's own blood into the epidural space in the spine to seal a leak of cerebrospinal fluid (CSF). This procedure is commonly performed to alleviate headaches caused by low CSF pressure.

Purpose

The primary purpose of an epidural blood patch is to treat spinal headaches, which are often caused by a leak of CSF, typically following a lumbar puncture or spinal anesthesia. The goal is to seal the leak and restore normal pressure, thereby alleviating the headache and other associated symptoms.

Indications

• Severe headache following a lumbar puncture or spinal anesthesia
• Symptoms of low CSF pressure including nausea, vomiting, dizziness, and visual disturbances
• Diagnosed CSF leak

Preparation

• Patients may be asked to fast for several hours before the procedure.
• Adjustments to medication, particularly blood thinners.
• Assessment of blood work to ensure normal clotting.
• Hydration may be encouraged prior to the procedure.

Procedure Description

1. The patient lies down in a prone or lateral position.
2. The lower back area is cleaned and sterilized.
3. Local anesthesia is administered to numb the injection site.
4. A small amount of the patient’s blood is drawn from a vein in the arm.
5. Using fluoroscopy for guidance, the drawn blood is injected into the epidural space of the spine at or near the site of the CSF leak.
6. The blood forms a clot, sealing the leak and restoring CSF pressure.

Duration

The entire procedure typically takes about 30 minutes to an hour.

Setting

The procedure is usually performed in a hospital setting, often in an interventional radiology or pain management department.

Personnel

• Anesthesiologist or pain management specialist
• Nurse or medical assistant
• Radiologist (if fluoroscopy is used)

Risks and Complications

• Common risks: mild back pain, temporary increase in headache
• Rare risks: infection, nerve damage, bleeding, persistent headache
• Management of complications usually involves observation, medications for pain/infection, or in very rare cases, surgical intervention.

Benefits

• Immediate to rapid relief from spinal headaches
• Restoration of normal CSF pressure
• Reduction in symptoms associated with low CSF pressure

Recovery

• Patients are typically monitored for a few hours post-procedure.
• Instructions may include avoiding heavy lifting or straining for several days.
• Most patients can resume normal activities within 24-48 hours.
• Follow-up appointments may be scheduled to monitor results.

Alternatives

• Conservative management with bed rest, hydration, and caffeine intake.
• Repeated lumbar punctures with CSF pressure monitoring.
• Surgical repair in very rare cases.

Pros: Immediate relief from debilitating headaches, minimally invasive.
Cons: Small risk of complications, discomfort from the procedure.

Patient Experience

During the procedure, patients might feel a brief pinch from the needle and some pressure as blood is injected. Post-procedure, mild back discomfort is common, but headaches usually improve promptly. Pain management typically includes over-the-counter pain relievers and adequate hydration.