A headache is the most common untoward complication of a spinaI puncture. Many conservative methods of treating post lumbar puncture headaches have been most unsatisfactory. However, use of an epidural blood patch which results in immediate and permanent relief of the headache has been well documented. This case report is that of a 38 year-old pregnant woman who developed a post spinal headache and was treated with repeated epidural blood patches 3 times. The patient had complained of a headache on the 1st postoperative day, then was started on conservative therapy such as fluid infusion, analgesics, etc., but there was no relief for her headache. An attempt at an epidural blood patch for treating headache was decided on the 2nd postoperative day. A lumbar puncture using a Tuohy needle was performed in a sitting position at the L 4-5 interspace, which was one interspace below the site punctured for the spinal anesthesis. Then l0 ml of autologaus blood was injected in the identified epidural space. The patient did well for 15 hours after the 1st attempt, until she started having the same intense headache, so that a 2nd attempt of using a blood patch with another 10 ml of autologous blood was carried out with the same good result. About 15 hours later, she started having a same kind of headache with neck rigidity. The 3rd attempt with a blood patch was considered again and lumbar tapping for the 3rd attempt was performed at the L 3-4 interspace which was the same level of puncture when the spinal anesthesia was performed. This last attempt resulted in permanent and satisfactory relief of headache with no untoward complications. However, possible complications from repeated blood patches should be seriously considered, and an absolute indication must be evaluated to avoid additional complications from the repeated blood patches. Possibilities of additional complications from repeated blood patches are as follows: l. Incidence of localized back pain is increased due to repeated puncture with a large bore needle. 2. Possibility of inadvertent subdural puncture is increased due to reduced epidural negative pressure by the preinjected hematoma formed in the epidural space. 3. Possibility of epidural abscess is increased by the repeated blood injection because blood is a good media for bacterial growth. 4. Chances of nerve root compression are increased due to repeated blood injections into the same area.
Analgesics ; Anesthesia, Spinal ; Back Pain ; Blood Patch, Epidural* ; Epidural Abscess ; Epidural Space ; Female ; Headache* ; Hematoma ; Humans ; Incidence ; Neck ; Needles ; Pregnant Women ; Punctures* ; Radiculopathy ; Spinal Puncture

Effortil is commonly used in this country as a vasopressor, replacing ephedrine. Various sbustances(i. e. ephedrine, neosynephrine, methedrin and epinephrine) have been added to spinal anesthetic agents in an attempt to prolong their action. We have used premixed 5% lidocaine with 5% dextrose solution as a main agent for spinal anesthesia for the past 6 years, and epinephrine has been used to prolong the spinal anesthesia. In this study, we have attempted to assess the possibility of the clinical use of Effortil in comparison with epinephrine for prologing the anesthetic effect of a spinal anesthetic agent. As a control group, 404 patients received premixed 5% lidocaine solution. In the 2nd group, 398 patients received 0. 2 mg of epinephrine added to the lidocaine solution. In the 3rd group, 337 patients received 3.0mg of Effortil added to the lidoeaine solution. The average duration of anesthetic effect was 97 minutes in the control group with lidocaine, 151 minutes in the 2nd group with epinephrine added to the lidocaine solution, and 113 minutes in the last group with Effortil added to the lidocaine solution. As a result of this study, we came to the conclusion that the Effortil may have a slight prolonging effect. However its effect is questionable as to its reliability for clinical use. Epinephrine is far better than Effortil and is more reliable and predictable for clinical use, as previously reported by other workers.
Anesthesia, Spinal* ; Anesthetics ; Ephedrine ; Epinephrine ; Etilefrine* ; Glucose ; Humans ; Lidocaine ; Phenylephrine