Continuous Spinal Anesthesia After Unintentional Dural Puncture in Parturients

Intrathecal catheterization after unintentional dural puncture during orthopedic surgery

“…Kuczkowski and Benumof [11] reported that only one of 7 parturients had a PDPH after an intrathecal catheter had been left in place for 12-20 h to provide analgesia after an unintentional dural puncture that occurred during epidural anesthesia. However, Norris and Leighton [14] and Rutter et al [15] in their studies found no advantage of inserting an epidural catheter into the intrathecal space after unintentional dural puncture, in terms of reducing PDPH. In their prospective study, Norris and Leighton [14] compared 35 patients who had undergone intrathecal catheterization and 21 patients who had a repositioned epidural catheter.…”

“…However, Norris and Leighton [14] and Rutter et al [15] in their studies found no advantage of inserting an epidural catheter into the intrathecal space after unintentional dural puncture, in terms of reducing PDPH. In their prospective study, Norris and Leighton [14] compared 35 patients who had undergone intrathecal catheterization and 21 patients who had a repositioned epidural catheter. All patients had received an anesthetic agent through the catheter for approximately 2 h during labor and delivery after unintentional dural puncture.…”

“…All patients had received an anesthetic agent through the catheter for approximately 2 h during labor and delivery after unintentional dural puncture. Those authors found no difference in the incidence of PDPH between the two groups [14]. Rutter et al [15] administered an epidural block to 15030 parturients during labor, and unintentional dural puncture occurred in 73 of those women.…”

“…Some studies have shown that leaving an epidural catheter in the dural tear for a certain duration reduces the incidence of PDPH [12,13]. However, other researchers have failed to note a difference in the incidence or severity of PDPH when a subarachnoid catheter was used [14,15]. Most of those studies were performed in obstetric patients who had a high risk of unintentional dural puncture and a high incidence of PDPH.…”

“…It has been suggested that after unintentional dural puncture with a Tuohy needle, immediate placement of an intrathecal catheter through the perforation produces thecal compression and may provoke an inflammatory reaction and reduce the incidence of PDPH as effectively as an epidural blood patch [10][11][12][13]. However, some studies have reported that this technique is ineffective in reducing the incidence of PDPH [14,15]. In these studies, however, the catheter was not left in place long enough to facilitate closure of the dural puncture.…”