Objective:

To assess the efficacy and safety of prophylactic epidural blood patch (PEBP) in preventing cerebrospinal fluid (CSF) leakage-related complications in patients with refractory cancer pain undergoing intrathecal drug delivery system (IDDS) implantation.

Approach:

• Method: label
• Method: text

Key Findings:

• PEBP was associated with lower rates of moderate-to-severe PHS (6.41% vs. 25.64%; p < 0.001) and an absolute risk reduction of 19.23%, corresponding to a number needed to treat (NNT) of approximately 5.
• Lower rates of exploratory imaging-confirmed CSF leakage were observed in the PEBP group (7.69% vs. 24.36%; p = 0.003).
• The need for remedial EBP was reduced in the PEBP group (2.56% vs. 15.38%; p = 0.006).
• Headache duration and hospital stay were shorter in the PEBP group.
• Minor adverse events occurred in 11.54% of PEBP patients, with no clinically evident neuraxial seeding during follow-up.

Interpretation:

Intraoperative PEBP was associated with fewer early CSF leakage-related complications and shorter recovery in patients with refractory cancer pain.

Limitations:

• The study is retrospective and non-randomized, which may introduce bias.
• Subgroup findings were exploratory and require further validation.
• Long-term safety and patient-centered benefits of PEBP remain unconfirmed.

Conclusion:

The findings support further prospective evaluation of PEBP in carefully selected patients, with prospective randomized controlled trials warranted to validate results.