Who Performs an Epidural Blood Patch
An epidural blood patch should be performed by an anesthesiologist or pain physician with expertise in neuraxial procedures, ideally under fluoroscopic guidance for optimal accuracy and safety. 1
Qualified Practitioners
Anesthesiologists are the primary specialists who perform epidural blood patches, as they have extensive training and experience with neuraxial procedures and have used this technique for many years with good results 2
Pain physicians are also qualified to perform this procedure, particularly when managing complex cases of CSF leakage or spontaneous intracranial hypotension 1, 3
The procedure should be performed by clinicians experienced in epidural techniques, as proper placement and technique are critical for both efficacy and safety 1
Procedural Setting and Guidance
Fluoroscopic guidance is strongly recommended for epidural blood patch procedures, particularly in complex cases where the leak site may not be clearly identified or when multiple-site administration is needed 1, 4
The procedure should be performed in a facility equipped with biplane fluoroscopy when dealing with spontaneous intracranial hypotension or unclear leakage sites, allowing for accurate catheter manipulation and blood administration 4
In obstetric settings, anesthesiologists routinely perform epidural blood patches for post-dural puncture headache following labor epidurals or spinal anesthesia 5
Important Clinical Context
While radiologists, neurologists, and other specialists who perform lumbar punctures may encounter post-dural puncture headache in their patients, they rarely perform the epidural blood patch themselves 2. Instead, these specialists should refer patients to anesthesiology or pain medicine for the procedure 1.
The technique requires specific expertise in epidural space identification, sterile technique, and management of potential complications such as high spinal block or infection 5, 1. This is not a procedure that should be attempted by clinicians without formal training in neuraxial techniques.