Presented at the 2013 AAPM Annual Meeting « Back

Treatment Options for Post-Dural Puncture Headache Secondary to Intrathecal Drug Delivery System Placement— A Mayo Clinic Experience

Wenchun Qu, MD PhD, qu.wenchun@mayo.edu¹, Bryan Hoelzer, MD¹, Susan M. Moeschler, MD¹, Eric Freeman, MD¹, Stephanie A. Neuman, MD², Jason Eldrige, MD¹, (1) Mayo Clinic, Rochester, Minnesota, (2) Mayo Clinic, La Crosse, Wisconsin

Introduction/Statement of the Problem: Due to the large needle size required for introthecal drug delivery system (IDDS) placement, one of the most common adverse effects is post-dural puncture headache. Little has been described on the details of blood patch therapy in the setting of the management of PDPH secondary to IDDS placement. This report presents specific details of our experience. Materials and Method: This retrospective cohort study is based on a 20 year chart review at Mayo Clinic Rochester, MN. Institutional review board approval obtained. All patients who underwent the placement of IDDS during the period between June 1, 1989 and May 31, 2009 were included. Results: We reviewed 319 surgical cases performed on 285 unique patients. Seventy three patients developed PDPH. Fourteen patients received epidural blood patch therapy, of which 1 blood patch was performed at L1-2, 3 at L3-4, 5 at L4-5, 3 at L5-S1, and 2 without clear statement of exact level, of which one was recorded as one level below the catheter entry level identified under fluoro, and one unknown. The catheter entry level were distributed as 3 at L1-2, 5 at L2-3, 3 at L3-4, 1 at L4-5, and 2 without specific statement. With regard to the level of blood patch relevant to catheter entry level, 7 were one level below, 5 were 2 levels below, 1 were 4 levels below and one unknown. Conclusions: Most common levels of blood patch were at L3 through S1, which were most commonly 1 or 2 levels below catheter entry level. References: 1) Deer TR, et al. Polyanalgesic Consensus Conference-2012: Recommendations to Reduce Morbidity and Mortality in Intrathecal Drug Delivery in the Treatment of Chronic Pain. Neuromodulation. 2012 Jul 31. doi: 10.1111/j.1525-1403.2012.00486.x. [Epub ahead of p 2) Deer TR, et al. Polyanalgesic Consensus Conference 2012: Recommendations for the Management of Pain by Intrathecal (Intraspinal) Drug Delivery: Report of an Interdisciplinary Expert Panel. Neuromodulation. 2012 Jul 2. doi: 10.1111/j.1525-1403.2012.00476.x.

Funding: None

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