The incidence of ADP, PDPH and blood patching is similar with previously published studies. After witnessed ADP, inserting the epidural catheter intrathecally significantly reduced the incidence of PDPH.

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A ccidental dural puncture (ADP) during epidural insertion occurs in 0% to 6.6% of obstetric patients, with postdural puncture headache (PDPH) developing in >50% of the patients who experience ADP. Epidural blood patch (EBP) is a common therapeutic option for PDPH. A potential means to prevent the development of a PDPH after ADP is the insertion of an intrathecal catheter at the time of the dural puncture. This maneuver avoids the need to perform another attempt at locating the epidural space with the accompanying risk of a second dural puncture and also provides immediate analgesia. This systematic review and meta-analysis was undertaken with relevant articles identified in which the effect of intrathecal catheter insertion on the development of PDPH, the need for EBP, and the incidence of adverse events was reported.The systematic literature search was conducted using PubMed and EMBASE databases, abstract supplements from annual meetings of American and European anesthesiology, and regional anesthesia societies held during the last 10 years, and the controlled trials registry. Outcomes obtained from the articles for analysis were the incidence of PDPH and the need for EBP. The meta-analysis was performed using Review Manager (v5.1). The random effects model was used and pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.Nine of the 49 retrieved studies were included in the meta-analysis, which included data about PDPH from 963 parturients and data about EBP from 939 patients. The RR of PDPH after intrathecal catheter insertion was 0.82 when compared with controls who did not receive an intrathecal catheter (95% CI, 0.67-1.01; P = 0.06). The RR for EBP was 0.64 (95% CI, 0.49-0.84; P = 0.001).This meta-analysis found that the insertion of an intrathecal catheter after ADP led to a significant reduction in the need for an EBP, whereas the risk of developing PDPH was not significantly different between those receiving an intrathecal catheter and controls. As ADP is a rare event, a sufficiently powered randomized controlled trial investigating the use of intrathecal catheters after ADP would require a large number of patients, which would be expensive and time consuming. The findings from this meta-analysis indicate that the use of an intrathecal catheter is a possible intervention for parturients who experience ADP during placement of an epidural catheter.COMMENT "Do over" is slang for "to do something over again," which means to repeat an action. It is frequently claimed by children, golfers, or bowlers when they are not satisfied by the outcome of an action. It is also being used by one of the authors of the current meta-analysis, Dr van de Velde, in regard to the value of intrathecal catheters after ADP.The use of intrathecal catheters for the prevention of postdural puncture headache after ADP was first postulated by Norris and Leighton, 1 who failed to note any difference in the incidence or severity of headache with the placement of a subarachnoid catheter. Ayad et al 2 changed this ...