This study was approved by the University of Washington Human Subjects Committee (Applications #47317 and 43939), which waived the requirement for written informed consent. This article adheres to the Consolidated Standards of Reporting Trials (CONSORT), adhering to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for observational studies. 1 The project was initiated by the SASM Death and Near Miss Registry (OSA Registry) Committee, which developed the case report form. Case report forms were publicly available on the Closed Claims Project (CCP) website from 2014 to 2016. To elicit cases, the project was publicized through the CCP website, by newsletter articles 2-7 and public presentations to elicit case reporting. Cases were also collected from anesthesiologist malpractice insurers by CCP anesthesiologist-reviewers during 2014-2016 in conjunction with regular data collection for the CCP and passed through to the OSA Registry. In addition, a query of the CCP database was conducted to capture previously collected cases in that project database that met OSA Registry inclusion criteria and had sufficient details to complete the OSA case report form. Cases were collected without patient, physician, or hospital identifiers. Case submission was
Perioperative complications related to OSA are increasingly being reported as the central contention of malpractice suits. These cases can be associated with severe financial penalties. These data likely underestimate the actual medicolegal burden, given that most such cases are settled out of court and are not accounted for in the legal literature.
BackgroundVarious interventions have shown promise in reducing complications following accidental dural puncture. However, these have yet to be studied as a single, comprehensive protocol. The aim of this study is to compare outcomes associated with the use of a continuous spinal protocol for labor pain relief versus resiting the epidural catheter following accidental dural puncture.MethodsWe reviewed the charts of patients managed via our continuous spinal protocol and compared this group with patients for whom the epidural was resited following accidental dural puncture during the 5-year period prior to implementing our protocol. We assessed incidence of postdural puncture headache, epidural blood patch, frequency of catheter replacement, use of pressors, verbal pain scores at 0, 1, 2, 3, 4 hours following catheter placement, infection rates (meningitis/epidural abscess) and mode of delivery.ResultsThere were 129 women in the continuous spinal protocol group and 52 in the resited epidural group. The incidence of postdural puncture headache was lower in the continuous spinal group versus the resited epidural group (21.7% vs 67.3%, p<0.001), and the incidence of epidural blood patch was lower in the continuous spinal group versus the resited epidural group (12.4% vs 50.0%, p<0.001). Verbal pain scores were consistently lower in the continuous spinal group compared with the resited epidural group at all time intervals studied.ConclusionPatients managed via this continuous spinal protocol had significantly lower incidence of postdural puncture headache and epidural blood patch with more effective labor analgesia following accidental dural puncture.
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