Preliminary findings and outcomes associated with the use of a continuous spinal protocol for labor pain relief following accidental dural puncture

2019 ◽  
pp. rapm-2019-100544
Author(s):  
Marcos Izquierdo ◽  
Xiao-Feng Wang ◽  
Karl Wagner III ◽  
Cristian Prada ◽  
Augusto Torres ◽  
...  
Keyword(s):  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Group Versus ◽  
Labor Pain ◽  
Postdural Puncture Headache ◽  
Epidural Group ◽  
Pain Scores ◽  
Blood Patch ◽  
Accidental Dural Puncture ◽  
Spinal Group

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.

Accidental dural puncture, postdural puncture headache, intrathecal catheters, and epidural blood patch: revisiting the old nemesis

2013 ◽  
Vol 28 (4) ◽  
pp. 628-630 ◽  
Author(s):  
Roland Kaddoum ◽  
Faisal Motlani ◽  
Romeo N. Kaddoum ◽  
Arvi Srirajakalidindi ◽  
Deepak Gupta ◽  
...  
Keyword(s):  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Postdural Puncture Headache ◽  
Blood Patch ◽  
Accidental Dural Puncture

scholarly journals Cosyntropin for Prophylaxis against Postdural Puncture Headache after Accidental Dural Puncture

2010 ◽  
Vol 113 (2) ◽  
pp. 413-420 ◽  
Author(s):  
Sameh Michel Hakim
Keyword(s):  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Control Group ◽  
Postdural Puncture Headache ◽  
Kaplan Meier ◽  
Significant Prolongation ◽  
Group I ◽  
Blood Patch ◽  
Accidental Dural Puncture ◽  
Group 5

Background The aim of the current study was to investigate the effect of administration of cosyntropin after accidental dural puncture (ADP) on the incidence of postdural puncture headache (PDPH) and the need for therapeutic epidural blood patch (EBP). Methods Ninety parturients who suffered an ADP were studied. After delivery, patients were randomly assigned to one of two equal-sized groups. In group I (cosyntropin group), patients received cosyntropin in a dose of 1 mg intravenously. In group II (control group), patients received an equal volume of normal saline. Results Fifteen patients (33%) in the cosyntropin group suffered from PDPH, compared with 31 patients (68.9%) in the control group (P = 0.001). Significantly fewer patients in the cosyntropin group required an EBP, compared with the control group (5 patients [11.1%] vs. 13 patients [28.9%], respectively; P = 0.035). The Kaplan-Meier curves for the occurrence of PDPH showed a hazard ratio of 0.32 (95% CI = 0.16-0.55, P &lt; 0.0001). The time from ADP to occurrence of PDPH was significantly longer in the cosyntropin group (27.2 [7.7] h) in comparison with the control group (17.5 [4.9] h; P &lt; 0.001). However, there were no statistically significant differences among patients who developed PDPH in both groups with regard to the severity or duration of PDPH or with regard to the need for EBP or for repeat EBP (P &gt; 0.05). Conclusions Administration of cosyntropin after ADP in parturients was associated with significant reduction in the incidence of PDPH and need for EBP and significant prolongation of the time from ADP to occurrence of PDPH.

scholarly journals Postpartum cerebral ischaemia after accidental dural puncture and epidural blood patch

2003 ◽  
Vol 90 (1) ◽  
pp. 98-100 ◽  
Author(s):  
M. Mercieri ◽  
A. Mercieri ◽  
S. Paolini ◽  
R. Arcioni ◽  
D. Lupoi ◽  
...  
Keyword(s):  
Cerebral Ischaemia ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Blood Patch ◽  
Accidental Dural Puncture

scholarly journals Punção Acidental da Dura e Cefaleia Pós-punção da Dura na População Obstétrica: Oito Anos de Experiência

2016 ◽  
Vol 29 (4) ◽  
pp. 268
Author(s):  
Maria Vaz Antunes ◽  
Adriano Moreira ◽  
Catarina Sampaio ◽  
Aida Faria
Keyword(s):  
Conservative Treatment ◽  
Epidural Catheter ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Spinal Block ◽  
Post Dural Puncture Headache ◽  
Retrospective Audit ◽  
Prophylactic Measures ◽  
Blood Patch ◽  
Accidental Dural Puncture

<p><strong>Introduction:</strong> Accidental dural puncture is an important complication of regional anesthesia and post-dural puncture headache remains a disable outcome in obstetric population. The aim of our study was to calculate the incidence of accidental puncture and post-puncture headache and evaluate its management among obstetric anesthesiologists.<br /><strong>Material and Methods:</strong> We conducted a retrospective audit, between January 2007 and December 2014. We reviewed the record sheets of patients who experienced either accidental puncture or post-puncture headache. We excluded the patients undergoing spinal block. We use the SPSS 22.0 for statistical analyses.<br /><strong>Results:</strong> We obtained 18497 neuro-axial blocks and 58 accidental dural punctures (0.3%). After detected puncture, in 71.4% epidural catheter was re-positioned and 21.4% had intra-thecal catheters. Forty-five (77.6%) developed headache and the prophylactic measures were established in 76.1%. Conservative treatment was performed in all patients. The epidural blood patch was performed in 32.8% with a 84.2% of success.<br /><strong>Discussion:</strong> The incidence of post-dural puncture headache is unrelated to the type of delivery or insertion of intrathecal catheter. The re-placement of the epidural catheter remains the main approach after puncture. The institution of prophylactic measures is a common practice, despite the low level of evidence. We performed epidural blood patch after failure of conservative treatment.<br /><strong>Conclusion:</strong> The incidence of accidental dural puncture and post-dural puncture headache was similar to the literature. Despite being a common complication, there remains lack of consensus on its approach.</p>

scholarly journals Targeted Transforaminal Epidural Blood Patch for Postdural Puncture Headache in Patients with Postlaminectomy Syndrome

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Yu Na Choi ◽  
Sang Ji Kang ◽  
Jin Deok Joo ◽  
Yu Mi Kim ◽  
Jang Hyeok In ◽  
...  
Keyword(s):  
Gold Standard ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Therapeutic Option ◽  
Severe Headache ◽  
Low Back ◽  
Postdural Puncture Headache ◽  
Lower Back ◽  
Interlaminar Approach ◽  
Blood Patch

Postdural puncture headache is a leak of cerebrospinal fluid that lowers intracranial pressure and usually presents as a positional headache. If conservative treatments are not successful, the epidural blood patch is the gold standard of the treatment for dural puncture. The interlaminar approach is the most commonly used technique for an epidural blood patch. This case report describes a patient who was treated with a transforaminal epidural blood patch for postdural puncture headache following an acupuncture procedure on his lower back after two epidural blood patches using an interlaminar approach had failed. The patient underwent an acupuncture therapy for management of chronic low back pain due to postlaminectomy syndrome. After the procedure, the patient had a severe headache and the conservative treatment was not effective. The two interlaminar epidural blood patches at the L2–3 level and at the L3–4 level were failed. We performed transforaminal epidural blood patch at the L3–4 and L4–5 levels on the left side, the site of leakage in the MRI myelogram. His symptoms finally subsided without complication. This case demonstrates that targeted transforaminal epidural blood patch is a therapeutic option for the treatment of postdural puncture headache when epidural blood patch using an interlaminar approach is ineffective.

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