Effect of neuraxial technique after inadvertent dural puncture on obstetric outcomes and anesthetic complications

Insertion of an intrathecal catheter in parturients reduces the risk of post-dural puncture headache: A retrospective study and meta-analysis

“…Although this meta-analysis included nine reports, among them, three were abstracts of a conference, and they were not published at full length. Since the last meta-analysis was performed, several relevant studies have been published [1, 3, 8, 13, 14, 18]. Most interestingly, Verstraete et al [8] and Kaddoum et al [13] both reported that the application of intrathecal catheter following ADP reduced the risk of PDPH in obstetric patients.…”

Changing Trends in the Management of Accidental Dural Puncture during Labor Epidural Analgesia: A Narrative Review and Recent Updates

“…Most of the studies are retrospective and focused mainly on the managements of accidental dural puncture with the intrathecal catheters compared to repeat epidural catheters [11,18,[26][27][28][29][30][31][32][38][39][40]. In most of these analgesia was established with a lower dose local anaesthetist (bupivacaine 1.25-5 mg or ropivacaine 1.75-10 mg) combined with either fentanyl 12.5-25 mcg or sufentanil 2-7.5 mc; and maintained commonly with continuous infusion of low concentration local anaesthetist with opioid either bupivacaine 0.04-0.1% or ropivacaine 0.1-0.2% with either fentanyl 2-2.5 mcg/ ml or sufentanil 0.75-1.0 mcg/ml at a rate of 1-3 ml per hour [11,18,[26][27][28][29][30][31][32]39], whereas, only few studies has used intermittent bolus or patient controlled analgesia [29,34,41]. Some authors suggest to use 10% of the epidural dose for both intrathecal bolus and continous infusion [41].…”

“…Once the surgical anaesthesia is and risk of repeat dural puncture [25]. Several studies claim that intrathecal catheter after accidental dural puncture reduces both the incidence and severity of PDPH, however, the evidence is conflicting as most data come from retrospective studies and proper well design randomised clinical trials are lacking [8,19,25,26,[27][28][29][30][31][32]. There are some drawbacks and potential risks of intrathecal catheters such as accidental medication error, risk of infection or injury to the spinal cord or nerve roots [33][34][35][36][37].…”

“…Once the catheter is passed into subarachnoid space, it should be clearly label in the catheter tubing, connection and syringe pump with bold letter as intrathecal catheter and all the staffs caring the patients should be aware of the intrathecal catheter. Patient should be informed about the intrathecal placement of the catheter as well clear documentation in the medical record to be done, all medications to be administered by anaesthetist only [32].…”

“…6. All patients with the intrathecal catheter are to be monitored as patients with epidural detail handover at each shift change, and allowing only anaesthetists to administer medications through the intrathecal catheter [32].…”