Lumbar puncture: epidural blood patching may reduce headache

Clinical bottom line (level 1a)

  1. Patients with a dural puncture who receive an epidural blood patch compared with no patch are probably less likely to develop a headache (NNT = 2 at days) .
Sudlow and Warlow: Cochrane Library 2001; 2 : -
Expires June 2004

The study

Systematic review of all randomised controlled trials of
  • Patients: dural puncture
  • Intervention: epidural blood patch compared with no blood patch
  • Outcome: post-dural puncture headache

Articles found in ?all languages using Cochrane Controlled Trials Register, Medline, Embase, to December 2000 (search terms: detailed in text ) and searching

Selection criteria: by 2 reviewers
Appraisal criteria: by 1 reviewer based on randomisation, blinding, intention-to-treat, completeness of follow-up
Articles excluded if:
3 RCTs involving 77 patients; 2 involving 65 patients undergoing preventive blood patching, and 1 involving 12 patients with persistent headache following dural puncture.

The evidence

Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
prevention of post-dural puncture headache days 28/35
(80.0%)		 0.06
(0.02 to 0.15) 		2
(1 to 2)

  • 1/10 of patients with persistent post-dural puncture headache treated with epidural blood patch continued to have a headache compared with 7/11 of those who did not.

Comments

  1. No study reported randomisation methods. Combined with the small numbers, this makes these results less certain.

Citation

  1. Sudlow C, and Warlow C: epidural blood patching for preventing and treating post-dural puncture headache (Cochrane Review). Cochrane Library 2001; 2 : -
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, June 2002
Reviewer:

Clinical Question.
Patient lumbar puncture
Intervention or Exposure epidural blood patch
Comparison no epidural blood patch
Outcome post-dural puncture headache