title: A new approach using high volume blood patch for prevention of post-dural puncture headache following intrathecal catheter pump exchange.
abstract: BACKGROUND
  In an observational study, complications of intrathecal catheter pumps necessitating surgical exchange were analyzed. Also the use of a high-volume prophylactic epidural blood patch (EBP) during surgery for preventing post-dural puncture headache (PDPH) with a follow-up for 1 year is described.
  
  
  METHODS
  In 22 patients with refractory chronic pain of cancer/noncancer origin or severe spasticity, who were receiving intrathecal morphine including adjuvants or baclofen for symptom relief, catheter exchange with or without pump was performed. In patients with documented symptoms of PDPH following initial intrathecal catheter implantation, a prophylactic EBP with a high blood volume was used for PDPH prevention during surgery. Catheters were replaced using 40 mL EBP before entering dural space at a speed of 5mL/min into the epidural space. Patients were asked to quantify pain experience and functional ability.
  
  
  RESULTS
  From a sample of 72 patients admitted for catheter exchange with or without pump, 22 patients (33%) (12 male, 10 female) had a history of PDPH following initial implantation. Diagnostic and therapeutic measures occurring with malfunction of intrathecal catheter pump systems were described. Twenty-one patients were successfully treated with prophylactic EBP, while one patient could not be properly evaluated because of intracranial bleeding as the underlying disease.
  
  
  CONCLUSIONS
  A new approach using a high-volume prophylactic EBP for preventing PDPH following catheter exchange is presented. The efficacy and safety of this technique for 1 year follow-up have been evaluated and was found to be safe and potentially effective.
authors.affiliation: Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany ; Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany ; German Center for Neurodegenerative Diseases, Magdeburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Abdulla
authors.affiliation: Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany ; German Center for Neurodegenerative Diseases, Magdeburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Vielhaber
authors.affiliation: Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany ; German Center for Neurodegenerative Diseases, Magdeburg, Germany ; Leibniz Institute for Neurobiology, Magdeburg, Germany.
authors.forename: Hans-Jochen
authors.initials: HJ
authors.lastname: Heinze
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Klinikum Bernburg, Martin Luther-University Halle-Wittenberg, Bernburg, Germany ; Johannes Gutenberg University Mainz, Mainz, Germany.
authors.forename: Walied
authors.initials: W
authors.lastname: Abdulla
keywords: Epidural blood patch; intrathecal catheter; intrathecal pump; post-dural puncture headache