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June 10, 1974

The Prophylactic Epidural Blood Patch

Author Affiliations

Veterans Administration Hospital Hines, Ill

JAMA. 1974;228(11):1369-1370. doi:10.1001/jama.1974.03230360017007

To the Editor.—  Considering the successes claimed for the epidural blood patch (EBP) in curing postspinal headache (PSH), it seemed logical that prophylactic instillation of autologous blood into the epidural space immediately following dural puncture might stave off this unpleasant complication.Immediately after intrathecal injection of the spinal anesthetic, gentle traction was exerted on the syringe plunger, and the spinal needle gradually withdrawn. As soon as spinal fluid ceased to be aspirated, the needle was stopped in place—the assumption being that it was just outside the dura and thus in the epidural space. Two milliliters of autologous blood or 7 ml of normal saline solution (NSS) was instilled. Paired studies were carried out—one autologous blood to one NSS. Since the incidence of PSH increased with bigger-gauge spinal needles,1 a 20-gauge, disposable spinal needle was used in all cases. Observation was carried out for three days, and if headache occurred