Effect of Neuraxial Technique After Inadvertent Dural Puncture on Obstetric Outcomes and Anesthetic Complications

Jagannathan, D.K.; Arriaga, Alexander F.; Elterman, Kelly; Kodali, Bhavani Shankar; Robinson, Julian N.; Tsen, Lawrence C.; Palanisamy, Arvind

doi:10.1097/01.aoa.0000504751.80625.1c

Cited by 2 publications

(16 citation statements)

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“…Analgesia was maintained in almost all studies with a continuous infusion [2, 8, 18, 23–27, 31], except for two studies by Bolden et al, where details were not provided [19] and by Tien et al., where some patients were maintained with intermittent boluses only [28]. The continuous infusion consisted of low‐dose bupivacaine 0.0417–0.1% or ropivacaine 0.175–0.2% combined with fentanyl 2–2.5 µg.mL −1 or sufentanil 0.75–1 µg.mL −1 at a rate of 1–3 ml.h −1 [2, 8, 19, 23–28, 31].…”

Section: Resultsmentioning

confidence: 99%

“…Compared with an epidural catheter in labour, no study reported the use of more extensive cardiovascular or respiratory monitoring when an intrathecal catheter was in use [2, 18, 19, 23–25, 27]. One study reported greater vasopressor use in the intrathecal catheter group than in the re‐sited epidural group (33/129 (25.6%) vs. 2/52 (3.8%), p < 0.001, OR (95%CI) 8.59 (1.98–37.28) [18]; the cause of this difference was presumed to be the effect of the lidocaine/epinephrine test dose in the intrathecal vs. epidural space.…”

Section: Resultsmentioning

confidence: 99%

“…Whereas the majority of intrathecal catheters provide adequate analgesia as detailed above, decreased effectiveness or failed analgesia have been reported [21, 27]. We therefore provide a ‘troubleshooting’ algorithm for correcting suboptimal to adequate labour analgesia (Figure 2).…”

Section: Resultsmentioning

confidence: 99%

“…Details on intrathecal catheter duration are listed in online Supporting Information Table S2. All studies [8, 15, 19, 21–23, 25, 27] compared intrathecal catheters with re‐sited epidurals. Ayad et al.…”

Section: Resultsmentioning

confidence: 99%

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Intrathecal catheter use after accidental dural puncture in obstetric patients: literature review and clinical management recommendations

et al. 2021

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Summary If an accidental dural puncture occurs, one option is to insert a catheter and use it as an intrathecal catheter. This avoids the need for a further injection and can rapidly provide labour analgesia and anaesthesia for caesarean section. However, there are no recommendations for managing intrathecal catheters and, therefore, significant variation in clinical practice exists. Mismanagement of the intrathecal catheter can lead to increased motor block, high spinal anaesthesia, drug error, hypotension and fetal bradycardia. Care must be taken with an intrathecal catheter to adhere to strict aseptic technique, meticulous labelling, cautious administration of medications and good communication with the patient and other staff. Every institution considering the use of intrathecal catheters should establish a protocol. For labour analgesia, we recommend the use of dilute local anaesthetic agents and opioids. For caesarean section anaesthesia, gradual titration to the level of the fourth thoracic dermatome, with full monitoring, in a facility equipped to manage complications, should be performed using local anaesthetics combined with lipophilic opioids and morphine or diamorphine. Although evidence of the presence and duration of intrathecal catheters on the development of post‐dural puncture headache and need for epidural blood patch is limited, we suggest considering leaving the intrathecal catheter in for 24 hours to reduce the chance of developing a post‐dural puncture headache while maintaining precautions to avoid drug error and cerebrospinal fluid leakage. Injection of sterile normal saline into the intrathecal catheter may reduce post‐dural puncture headache. The level of evidence for these recommendations was low.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Intrathecal catheter use after accidental dural puncture in obstetric patients: literature review and clinical management recommendations

et al. 2021

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“…In a single United States tertiary care institution, 73% of 235 parturients over a 5-yr period had an intrathecal catheter placed after an unintentional dural puncture. 15 In the United Kingdom, a 2005 study of maternity units found that placement of intrathecal catheter after unintentional dural puncture was common in 59% of the units, whereas a 2018 study in Canada found that 30% of anesthesia providers placed an intrathecal catheter after unintentional dural puncture. 16,17 Neuraxial labor analgesia is maintained with a continuous intrathecal infusion of a long-acting amide local anesthetic (e.g., bupivacaine) and lipid-soluble opioid (e.g., fentanyl).…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Intrathecal Morphine and Prevention of Post–Dural Puncture Headache

et al. 2020

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Background Prophylactic epidural morphine administration after unintentional dural puncture with a large-bore needle has been shown to decrease the incidence of post–dural puncture headache. The authors hypothesized that prophylactic administration of intrathecal morphine would decrease the incidence of post–dural puncture headache and/or need for epidural blood patch after unintentional dural puncture. Methods Parturients with an intrathecal catheter in situ after unintentional dural puncture with a 17-g Tuohy needle during intended epidural catheter placement for labor analgesia were enrolled in this randomized, double-blind trial. After delivery, subjects were randomized to receive intrathecal morphine 150 µg or normal saline. The primary outcome was the incidence of post–dural puncture headache. Secondary outcomes included onset, duration, and severity of post–dural puncture headache, the presence of cranial nerve symptoms and the type of treatment the patient received. Results Sixty-one women were included in the study. The incidence of post–dural puncture headache was 21 of 27 (78%) in the intrathecal morphine group and 27 of 34 (79%) in the intrathecal saline group (difference, −1%; 95% CI, −25% to 24%). There were no differences between groups in the onset, duration, or severity of headache, or presence of cranial nerve symptoms. Epidural blood patch was administered to 10 of 27 (37%) of subjects in the intrathecal morphine and 11 of 21 (52%) of the intrathecal saline group (difference 15%; 95% CI, −18% to 48%). Conclusions The present findings suggest that a single prophylactic intrathecal morphine dose of 150 µg administered shortly after delivery does not decrease the incidence or severity of post–dural puncture headache after unintentional dural puncture. This study does not support the clinical usefulness of prophylactic intrathecal morphine after an unintentional dural puncture. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Effect of Neuraxial Technique After Inadvertent Dural Puncture on Obstetric Outcomes and Anesthetic Complications

Cited by 2 publications

References 1 publication

Intrathecal catheter use after accidental dural puncture in obstetric patients: literature review and clinical management recommendations

Intrathecal catheter use after accidental dural puncture in obstetric patients: literature review and clinical management recommendations

Prophylactic Intrathecal Morphine and Prevention of Post–Dural Puncture Headache

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