Case Report: Portable X-Ray Guided Blood Patch in Treating Post Dural Puncture Headache Status Post Intrathecal Pump Placement

Mark Li,1 Dominic Nistal,2 Ryu Komatsu,3 Jiang Wu1 1Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, USA; 2Department of Neurological Surgery, University of Washington Medical Center, Seattle, WA, USA; 3Multi-Specialty Anesthesiology, Integrated Hospital-Care Institute, Cleveland Clinic, Cleveland, OH, USACorrespondence: Jiang Wu, Email [email protected]: Post dural puncture headache (PDPH) is common after placement of an intrathecal pump (ITP). Treatment of refractory PDPH requires an epidural blood patch (EBP) with fluoroscopic guidance to avoid damaging the intrathecal catheter. However, when patients’ symptoms are severe and advanced imaging resources are unavailable, a safe and effective alternative would need to be explored. Here, we describe a successful application of portable X-ray in guiding EBP in the post-anesthesia care unit (PACU) to treat a patient with refractory and debilitating PDPH status post ITP placement. This approach afforded us the advantage of portability as well as real-time imaging guidance in a resource limited setting. The patient’s PDPH resolved after the procedure and remained headache-free two months later at follow up with a functioning ITP in place.Keywords: lumbar epidural, intrathecal catheter, fluoroscopic guidance, post-anesthesia care unit, PACU