• Reference Number: HEY201/2025
• Departments: Anaesthetics
• Last Updated: 30 June 2025

This leaflet has been produced to give you general information about Epidural Blood Patch (EBP). You may need an EBP as a treatment for headache that has developed after your spinal/epidural injection. Most of your questions should have been answered by this leaflet. It is not intended to replace the discussion between you and your anaesthetist but may act as a starting point for discussion. If, after reading this, you have any concerns or require further explanation, please discuss this with a member of the healthcare team who has been caring for you.

Introduction

Some mothers develop headache following a spinal or epidural injection in the back during childbirth. This headache is called post-dural puncture headache and is explained in the leaflet “Headache after spinal/epidural injection’. If it does not settle with painkillers and other simple measures, the anaesthetist may offer you a treatment called an epidural blood patch. This leaflet has been produced to give you general information about this treatment.

What is a Blood Patch (EBP)?

Epidural blood patch consists of injecting a small amount of your own blood, taken from a vein on your arm, into the epidural space. The blood seals the hole through which the fluid bathing the spinal cord is leaking out and so helps to stop headache. In 70% of patients, headache is cured completely. In 25% of patients, a second blood patch may be needed.

Why do I need it?

When an epidural is placed in the lower back, a needle is used to position a fine tube called a catheter just outside the bag of fluid bathing the spinal cord. The fluid is held in place by a thin membrane (dura). Local anaesthetic is injected through this tube to provide relief from labour pain. Occasionally the needle can accidentally make a hole in the dura. When a spinal anaesthetic is given, a fine needle is inserted intentionally through the dura to inject local anaesthetic directly into the bag of fluid.

As a consequence of making a hole in the dura, fluid tends to leak out causing a drop in pressure in the bag. This produces the symptoms of the headache called post dural puncture headache. Some patients describe it as a very bad migraine which is made worse when sitting or standing up.

You may have already been offered treatment for the headache in the form of painkillers, bed rest and plenty of oral fluids. If this has not worked the anaesthetist may offer you a treatment called blood patch.

Can there be any complications or risks?

Local bruising and temporary backache, lasting a few days is the most common complication of blood patch. There is a small chance (less than 1%) of creating   another accidental hole in the bag of fluid bathing the spinal cord similar to what caused the post dural puncture headache. Infection, nerve damage or bleeding into your back are other rare complications.

How do I prepare for the blood patch?

Please read the information leaflet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this examination.

Your anaesthetist will discuss the procedure of epidural blood patch with you in greater detail and clarify any queries you may have. The anaesthetist may require you to have blood tests under certain circumstances. Reading this leaflet will prepare you for the procedure and if you have any doubts and/or questions, you can write it down and ask the anaesthetist before the procedure.

Do’s

• Continue taking paracetamol/codeine as usual.
• Continue your regular medications EXCEPT blood thinning drugs (Heparin, Fragmin and Warfarin) and drugs that affect blood clotting function (Clopidogrel and Ticlopidine)
• Warn the anaesthetist if you have had an injection of blood thinning drugs in the last 12 hours.
• Warn the anaesthetist if you have had fever or have not been feeling well in yourself in the last 24 hours.
• You will be asked to lie flat for some hours after the blood patch, so it is a good idea to go to the toilet beforehand.

Don’t

• There is no need to fast for this procedure.
• You do not need to stop breast feeding your baby.

What happens afterwards?

After a blood patch, your anaesthetist may ask you to lie flat in bed for 2 to 4 hours and not to lift anything heavy for at least two days.

In 60 to 70% patients, the blood patch will cure the headache within a few minutes to a few hours. If you still have a headache after 24-48 hours, you may be advised to have a second blood patch. It is very rare to need more than two. In some people, the headache goes away after the first blood patch, but then it returns. A second blood patch may then help. Your anaesthetist will discuss this with you.

If the anaesthetist is happy with your progress, he/she may allow you to go home 4 to 6 hours after the procedure.  You may need someone at home with you to help you with your daily activities.

This leaflet was produced by the Anaesthetics Department, Hull University Teaching Hospitals NHS Trust and will be reviewed in June 2028.