Epidural Blood Patch for Severe Post-Dural Puncture Headache in a Hypertensive Patient Following Spinal Anesthesia: A Case Report
DOI:
https://doi.org/10.59680/ventilator.v4i1.2495Keywords:
Cerebrospinal Fluid, Epidural Blood Patch, Hypertension, Post-Dural Puncture Headache, Spinal SnesthesiaAbstract
Post-dural puncture headache (PDPH) is a frequent complication following neuraxial anesthesia, resulting from cerebrospinal fluid (CSF) leakage and intracranial hypotension. Although typically self-limiting, severe PDPH can significantly impair patient function and delay recovery. Epidural blood patch (EBP) is considered the gold standard treatment for refractory cases; however, optimal volume and clinical considerations in patients with comorbidities such as hypertension remain underreported. We report a 45-year-old female with a history of hypertension who developed severe PDPH following spinal anesthesia for lymphadenectomy. The procedure required multiple attempts using a 25G Quincke needle. Within hours postoperatively, the patient experienced a classic orthostatic headache accompanied by photophobia, nausea, and inability to tolerate an upright position. Conservative management failed to provide improvement after 48 hours. An epidural blood patch using 10 mL of autologous blood was subsequently performed, resulting in rapid and significant symptom relief within one hour, followed by progressive clinical recovery over the next two days. This case highlights the importance of early recognition and timely intervention in PDPH, particularly in patients with overlapping symptoms such as hypertension. Notably, a lower-volume EBP (10 mL) demonstrated effective clinical outcomes, suggesting that individualized approaches may be sufficient in selected patients. Epidural blood patch remains a safe and effective definitive treatment for refractory PDPH.
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