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50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting
May 1 - 3, 2025 | Orlando, Florida
6677
ARACHNOIDITIS AFTER EPIDURAL BLOOD PATCH FOR INTRACRANIAL HYPOTENSION
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Medically Challenging Cases
Title: Arachnoiditis after Epidural Blood Patch for Intracranial Hypotension
BACKGROUND: Epidural blood patch (EBP) is an effective treatment for cerebrospinal fluid (CSF) leak; however, unintentional intrathecal injection of blood during this procedure can lead to complications that can potentially be debilitating.
CASE DESCRIPTION
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32 yo F G1P0 at 39w2d received combined spinal epidural (CSE) complicated by unintended dural puncture followed by post dural puncture headache (PDPH).
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EBP performed post-operative day (POD) 2 using landmark technique in sitting position at same level of dural puncture
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Improvement in PDPH over the next several hours and discharged home
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Patient presented POD 6 with continued radicular back pain with MRI imaging revealing subdural hematoma at L2-3 level with secondary adhesive arachnoiditis
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Conservative management with close follow up revealed improvement in symptoms without further intervention
DISCUSSION
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Epidural blood patch for PDPH is not without risk.
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Factors that increase risk: procedure error, large volume of injection, high speed/pressure of injection, injection at same level of dural puncture.
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This highlights importance of discussing with patients all risks associated with EBP including potentially debilitating complications.