Acupuncture instead of Epidural Blood Patch [EBP] and Post-dural puncture headache (PDPH) ?

[Guest guest]

Emmanuel

 

 

Alon,

 

Sometimes you shock me when you use precise anatomical language that would

generally only be learned in Western medical school or in a graduate PhD

program. " Potential space " indeed. Not the kind of thing learned at ACTCM ...

are you channeling clinical professors at UCSF?

 

Well stated.

 

Emmanuel Segmen

 

>>>>Emmanuel, for more shocking displays of advanced medical knowledge you

should check out Alon's acu/orthopedics classes. They're in san francisco, which

i believe is your nieghborhood. I've been doing the program and can vouch that

he knows more than they teach at ACTCM. i guess not everybody needs to go to med

school to learn medicine. Dean

 

[Guest guest]

The incidence of PDPH can range from 26-85+%, depending on the

experience of the operator, and on the gauge and type of needle

used.

>>>This number must be from spinal taps not from epidural blocks. It that common

after epidural blocks when done by a skilled dr

alon

 

 

[Guest guest]

Hi All,

 

Herbalists! Can you recommend a highly effectgive and reeliable

herbal remedy for Post-dural puncture headache (PDPH)?

 

Gabrielle wrote

> What is a blood patch? TCM? Western?

 

Jason replied

> … basically a blood patch is a procedure to stop [CSF] leakage.

 

Alon added:

> … you draw blood and inject it in the epidural space. This almost

> always stops the leak immediately as well as the related headache.

 

Post-dural puncture headache (PDPH) is very common after

puncture (more often accidental) of the dura mater in spinal taps of

epidural/spinal anaesthesia.It is attributed to CSF leakage and

resulting intracranial hypotension.

 

The incidence of PDPH can range from 26-85+%, depending on the

experience of the operator, and on the gauge and type of needle

used. Where possible, one should use 24-27 gauge needles, and

pencil-point needles (Sprotte or Whitacre) rather than cutting

needles (Atraucan or Quincke). These steps reduce the incidence

of PDPH significantly.

 

Epidural blood patch (EBP) has been used for >30 years to treat

PDPH. Even today, it is used widely. It involves injection of 5-20 ml

of the patient’s blood back into the epidural space.

 

Flender et al (1994) conclude that prolonged PDPH/ post-spinal

headache “should be treated by epidural blood patch. The use of

>10 ml cannot be generally recommended, although in this case

most of the blood patch of 15 ml was localized caudally. Careful

monitoring for side effects is necessary with blood volumes >10 ml.

If there is no immediate relief, conservative therapy with 24-48 h of

bedrest is recommended. If the headache persists a second blood

patch should be performed, with the volume and the probable

caudal spreading of the first taken into account”.

 

However, EBP is not without risk (Ezri et al 2002; Moral 2002) and

alternatives are being sought. Garcia et al (2000) suggest that

percutaneous injection of fibrin glue at the site of dural puncture

seems promising for the prophylaxis of headache associated with

CSF leakage, and may be an alternative to an epidural blood patch.

Moral et al (2002) suggest i/v hydrocortisone; they had excellent

results with it.

 

Acupuncture (AP) seems to be a likely alternative to EBP.

 

Lee JH & Lo J (1978, Minn Med. Jul;61(7):429-30) reported on AP

in treatment of chronic pain and post-lumbar puncture headache.

One year's experience.|PMID: 672868 [PubMed - indexed for

MEDLINE]. Unfortunately, I cannot get access to the abstract or

full text. Can any of YOU summarise their results?

 

Barrios-Alarcon et al (1989 Reg Anesth. Mar-Apr;14(2):78-80)

reported that painkillers, AP and EBP all failed to help 56 adults

with post-lumbar puncture headache (PLPH), whereas dextran

injection gave 100% satisfactory results. An average of 20 ml

dextran was injected epidurally over a period of 120 seconds with

patients in the sitting or lateral decubitus position. All patients

reported headache relief within 15 minutes to 24 hours. Follow-up

at 6-12 months revealed no recurrence. Burning sensation at the

injection site and dysesthesia at the time of injection were noted in

3.5% and 7.1% of patients, respectively. [PMID: 2484880 [PubMed

- indexed for MEDLINE]].

 

In marked contrast, Tsenov (An alternative method for treating

headache after spinal anesthesia in cesarean section. 1996 Akush

Ginekol (Sofiia).;35(4):6-7) reported 100% success with AP in 35

pregnant women with PDPH. AP was used 1-3 times at ST08,

LI04, GB11,14, BL10, GV14,20. Headache passed in 30/35 women

after 1 session, in 4/35 after 2 and in 1/35 after 3 sessions. PMID:

9254576 [PubMed - indexed for MEDLINE]

 

Have any of you used AP, especially Tianying AP - needling the

original puncture track – to treat PDPH? I have treated several

horses w acute sciatica and severe lameness [not putting the limb

to the ground] after some idiot had injected highly irritant Cu-EDTA

into the rump muscles over the sciatic nerve. As part of the AP

formula, I used dry-needling of the original needle-track with

excellent and rapid results.

 

AP should carry very low risk of adverse effects, and I have seen

somewhere [? In the Abstracts section of the American J Acup]

that Tianying AP was used successfully for that purpose.

 

If any of you want Medline abstracts relating to conventional

treatment of PDPH [EBP, hydrocortisone, etc], email me off-list

and I can send them on.

 

 

Best regards,

 

Email: <

 

WORK : Teagasc Research Management, Sandymount Ave., Dublin 4, Ireland

Mobile: 353-; [in the Republic: 0]

 

HOME : 1 Esker Lawns, Lucan, Dublin, Ireland

Tel : 353-; [in the Republic: 0]

WWW : http://homepage.eircom.net/~progers/searchap.htm

[Guest guest]

Hi All, & Hi Alon,

 

>> The incidence of PDPH can range from 26-85+%, depending on

the experience of the operator, and on the gauge and type of

needle used.

 

Alon wrote:

> This number must be from spinal taps not from epidural blocks. It

> that common after epidural blocks when done by a skilled dr?

 

Alon, you are correct. The DEFINITION of PDPH is headache after

dural PUNCTURE; indeed the most common view of the aetiology

is CSF leakage with cranial hypotension, and very rare

pneumocephalus.

 

My understanding is that in epidural injections/anaesthesia, one

aims to inject OUTSIDE the dura, i.e. one does not aim to puncture

the dura.

 

Therefore there should be no leakage of CSF. Therefore, compared

to a skilled doctor doing a spinal tap, a skilled doctor giving an

epidural injection should not have the same rate of post-procedure

headache.

 

But mistakes happen ... Accidental puncture of the dura can

happen even with epidurals.

 

Best regards,

 

Email: <

 

WORK : Teagasc Research Management, Sandymount Ave., Dublin 4, Ireland

Mobile: 353-; [in the Republic: 0]

 

HOME : 1 Esker Lawns, Lucan, Dublin, Ireland

Tel : 353-; [in the Republic: 0]

WWW : http://homepage.eircom.net/~progers/searchap.htm

[Guest guest]

My understanding is that in epidural injections/anaesthesia, one

aims to inject OUTSIDE the dura, i.e. one does not aim to puncture

the dura.

>>>You inject just after you brake through the ligament. Remember the epidural

at these levels is a potential space

Alon

 

 

[Guest guest]

My understanding is that in epidural injections/anaesthesia, one

aims to inject OUTSIDE the dura, i.e. one does not aim to puncture

the dura.

>>>You inject just after you brake through the ligament. Remember the epidural

at these levels is a potential space

Alon

 

Alon,

 

Sometimes you shock me when you use precise anatomical language that would

generally only be learned in Western medical school or in a graduate PhD

program. " Potential space " indeed. Not the kind of thing learned at ACTCM ...

are you channeling clinical professors at UCSF?

 

Well stated.

 

Emmanuel Segmen