Université Paris Saclay, AP-HP, Hôpital Bicêtre, Service d'Anesthésie Réanimation Médecine Péri Opératoire - 78, rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex, France.
Regenerative Pain Therapies Program (RPTP), Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, NC 27710, USA.
Anaesth Crit Care Pain Med. 2022 Oct;41(5):101138. doi: 10.1016/j.accpm.2022.101138. Epub 2022 Aug 2.
The epidural blood patch (EBP) is one of the most effective treatments for intracranial hypotension. Anesthesiologists are familiar with performing EBPs for the treatment of dural puncture-associated intracranial hypotension following spinal anesthesia, complicated epidural analgesia, and diagnostic lumbar puncture. Increasingly, EBPs are used to treat patients with spontaneous intracranial hypotension. However, the treatment of these non-iatrogenic conditions presents new therapeutic challenges. The purpose of this narrative review is to discuss both procedural and diagnostic considerations of EBP for the various presentations of intracranial hypotension and allow the clinician to tailor treatment for the patient, especially in the setting of diagnostic dilemmas. After discussing EBP history and relevant anatomy, we review mechanisms of action and clinical indications for this intervention. The contraindications, complications, and treatment alternatives to the blood patch are examined in detail. Finally, objective methods to evaluate the effectiveness of the EBP, such as MRI or Doppler ultrasound, are presented as novel methods that may improve future diagnostic accuracy and treatment success.
硬膜外血贴（EBP）是治疗颅内低血压最有效的方法之一。麻醉师熟悉在椎管内麻醉、复杂硬膜外镇痛和诊断性腰椎穿刺后治疗与硬脊膜穿刺相关的颅内低血压。EBP 越来越多地用于治疗自发性颅内低血压患者。然而，这些非医源性疾病的治疗带来了新的治疗挑战。本叙述性综述的目的是讨论 EBP 在各种颅内低血压表现中的程序和诊断注意事项，使临床医生能够根据患者的情况进行治疗，尤其是在诊断难题的情况下。在讨论 EBP 历史和相关解剖结构之后，我们回顾了该干预措施的作用机制和临床适应证。详细检查了血贴的禁忌证、并发症和治疗替代方法。最后，介绍了评估 EBP 效果的客观方法，如 MRI 或多普勒超声，这些方法可能是提高未来诊断准确性和治疗成功率的新方法。
