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After Care

Reviewed by Dr. Farnaz Amoozegar, MD, MSc, FRCPC

Page last updated: May 26

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AFTER AN EPIDURAL BLOOD PATCH

After being treated for a spinal CSF leak, there are steps that can be taken to enhance the prospect of being sealed.

It is recommended to remain flat on your back or on your side, keeping your head level with or lower than your chest as much as possible during the first 24 hours following the epidural blood patch or fibrin sealant injection. The only exceptions are brief time periods to eat or use the washroom; then return to lying down as soon as possible.

If you develop Rebound Intracranial Hypertension, reverse the pattern and remain upright in a reclining chair or prop up at night with pillows


NO Bending, lifting or twisting (No B.L.T.) in the days following the blood patch. The exact duration can be variable and should be discussed with the physician.

Activities can be resumed, however with some limitations to allow the patch to get stronger.  NO Bending - NO Lifting (not more than about 10 pounds) - NO Twisting.

Duke After Patch Protocol (Shared with permission)

Stanford After Patch Protocol (Shared with permission)

PROGNOSIS

Spinal CSF leaks are often treatable.  Once a leak has been successfully sealed, patients can be optimistic about the prognosis.  Many times, successful outcome will be measured in months rather than days. 

Key Notes

  • Discuss the recovery room protocol with the attending physician prior to treatment. Ideally, patients remain flat for at least one to two (2) hours following the epidural patch to allow the blood to travel along the spine.

  • It is recommended to remain flat for 24 hours following the epidural blood patch.  Upright only for bathroom breaks.

  • Cold packs may be helpful for back after the epidural blood patch which then gradually diminishes.

  • It is important to manage post-patch vomiting (if it is present). Discuss taking anti-nausea medication with the physician. Vomiting can generate pressure that may open up the leak.  Accordingly, managing vomiting will assist in preventing patch failure.

  • It is important to manage post-patch constipation.  Discuss taking an over-the-counter stool softener with the physician. Constipation and related over-exertion may lead to patch failure.

References & Suggested Reading