Letters to the Editor: Letters & Announcements
To the Editor:
We would like to react to the case report by Martin et al. (1) on the use of an epidural blood patch for postspinal headache in a patient with acute varicella because it appears to us that the authors were unaware of another, possibly safer, solution for these complaints.
A number of articles have reported the use of epidural injection of fibrin glue (Tissucol®) to be an effective and safe way to treat postspinal headache (2) and persistent cerebrospinal fluid leakage (3). Because the use of fibrin glue is routine in various neurosurgical operative procedures (4) and is prepared by a recombinant DNA technique by the manufacturer in Europe (Immuno AG, Austria), the possibility of viral transmission is extremely unlikely.
Although we are aware of the more or less standard procedure of epidural injection of autologous blood for this complaint (5), the potential viral load of the injectate in this patient would have made us reluctant to perform this procedure despite her antiviral treatment.
We are aware that a prospective comparison between epidural blood versus fibrin glue has not been performed, but the statement of the authors at the conclusion of their report that “epidural blood patch may be a safe therapeutic option for patients with postdural puncture headache in the context of acute varicella” can, in our view, not be shared in light of having access to a safer alternative.
Robert T. M. van Dongen, MD, PhD
Bas M. Gerritse, MD
Institute for Anesthesiology
Radboud University Medical Centre Nijmegen
Nijmegen, The Netherlands
1. Martin DP, Bergman BD, Berger IH. Epidural blood patch and acute varicella. Anesth Analg 2004;99:1760–2.
2. Crul BJ, Gerritse BM, van Dongen RT, Schoonderwaldt HC. Epidural fibrin glue injection stops persistent postdural puncture headache. Anesthesiology 1999;91:576–7.
3. Gerritse BM, van Dongen RT, Crul BJ. Epidural fibrin glue injection stops persistent cerebrospinal fluid leak during long-term intrathecal catheterization. Anesth Analg 1997;84:1140–1.
4. Wiegand DA, Hartel MI, Quander T, et al. Assessment of cryoprecipitate thrombin solution for dural repair. Head Neck 1994;16:569–73.
5. Harrington BE. Postdural puncture headache and the development of the epidural bloodpatch. Reg Anesth Pain Med 2004;29:136–63.