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

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 312 years, and 36 patients were adolescents, aged 1318 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 23/1000 in adolescents, and that after chemotherapy 12/1000. 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.