When should an epidural blood patch be performed in postlumbar puncture headache? A theoretical approach based on a cohort of 79 patients

The aim of the present study was to decide on which day in the course of postlumbar puncture headache (PPH) an epidural blood patch (EBP) should be performed to minimize suffering. A cohort of 79 patients (64 female, 15 male) was followed prospectively for 14 days and the consequences of performing an EBP on different days were studied. If no EBP was performed, the patients would accumulate 141 days with PPH5 (bedridden most of the day), 216 days with PPH4-5 (bedridden more than half the day), and 293 days with PPH3-5 (bedridden half the day or more). If these patients were patched on day 2, 3 or 4 after an initial observation of the PPH grade on day 1, the expected suffering was substantially reduced, and the more the earlier in the course the EBP was performed. If the strategy was to treat only patients with PPH5 with an expected 90% success rate, the reduction compared with no treatment was 50% if treated on day 2, 37% if treated on day 3, and 29% if treated on day 4. The corresponding figures for trea...