Insertion of an intrathecal catheter following a recognised accidental dural puncture reduces the need for an epidural blood patch in parturients: an Australian retrospective study. (November 2018)

• Record Type: Journal Article
• Authors: Rana, K.; Jenkins, S.; Rana, M.
• Is Part Of: International journal of obstetric anesthesia. Volume 36(2018)
• Page Start: 11
• Page End: 16
• Publication Date: 2018-11
• Subjects: Accidental dural puncture -- Post-dural puncture headache -- Epidural blood patch -- Intrathecal catheter; Obstetrics -- Periodicals; Anesthesia -- Periodicals; Anesthésie en obstétrique -- Périodiques; Anesthesia; Obstetrics; Electronic journals; Periodicals; 617.9682
• DOI: 10.1016/j.ijoa.2018.08.005
• Languages: English
• ISSNs: 0959-289X

Abstract

Highlights: Post-dural puncture headache is a common complication of accidental dural puncture. Intrathecal catheterisation did not significantly affect headache incidence. Intrathecal catheterisation reduced the need for an epidural blood patch (EBP). Intrathecal catheter for ≥24 h, compared to <24 h, did not change the EBP rate. Abstract: Background: There is no clear consensus about how best to prevent post-dural puncture headache (PDPH) following an accidental dural puncture in parturients. Our primary objective was to investigate whether the insertion of an intrathecal catheter following accidental dural puncture reduces the incidence of PDPH and therapeutic epidural blood patch. Methods: Anaesthetic records from January 2009 to December 2015 were reviewed retrospectively and parturients who had an accidental dural puncture and/or PDPH were identified. Data from those with a recognised dural puncture in whom an intrathecal catheter was inserted at the time of accidental dural puncture (ITC group) were compared to those without an intrathecal catheter (non-ITC group), as were outcomes of patients with an intrathecal catheter for ≥24 hours compared to <24 hours. Results: Of 94 recognised accidental dural punctures, 66 were in the ITC group (37 for ≥24 h) and 28 in the non-ITC group. In the ITC group, 22 (33.3%) required an epidural blood patch in comparison to 19 (67.9%) in the non-ITC group ( P <0.01, 95% CI 12.5 to 52.0). In the ITC group, 62 (93.9%) developed PDPH in comparison to 28 (100%) in the non-ITC group ( P =0.186, 95% CI −6.55 to 14.57). Intrathecal catheter insertion for ≥24 h obviated the need for an epidural blood patch in 28 (75.7%) parturients, compared to 13 (59.1%) if <24 h ( P =0.184, 95% CI −7.08 to 39.72). Conclusion: Inserting an intrathecal catheter after a recognised accidental dural puncture significantly reduced the need for an epidural blood patch.