• 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 to 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.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.