Effect of neuraxial technique after inadvertent dural puncture on obstetric outcomes and anesthetic complications |
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| Institution: | 1. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA;2. Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;1. Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel affiliated with Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel;2. Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel;3. Division of Anesthesia, Operating Rooms, Pain, and Critical Care, Samson Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod, Israel;4. Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Hebrew University Hadassah Medical School, Jerusalem, Israel;5. Department of Anesthesiology, Critical Care, and Pain Medicine, Hadassah Hebrew University Medical Center, Jerusalem affiliated with Hebrew University Medical School, Jerusalem, Israel;6. Shamir Medical Center, Zrifin, Israel affiliated with Sakler School of Medicine, Tel Aviv University, Tel Aviv, Israel;7. Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel;8. Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel affiliated with Faculty of Health Sciences Ben Gurion University, Israel;1. Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan;2. Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Fukushima, Japan;1. Columbia University Medical Center, Center for Precision Medicine, Department of Anesthesiology, Columbia University College of Physicians & Surgeons, 630 West 168th St PH-5 (5th Floor Office PH-546, 11th Floor Office CHN-1118), New York, NY 10032, USA;2. Columbia University, USA |
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| Abstract: | BackgroundThe aim of this study was to evaluate labor and delivery outcomes in parturients with inadvertent dural puncture managed by either insertion of an intrathecal catheter or a resited epidural catheter.MethodsThis was a retrospective cohort review of 235 parturients who had an inadvertent dural puncture during epidural placement over a six-year period. The primary outcome was the proportion of women with a delayed second stage of labor. Secondary outcomes were the proportion of cesarean deliveries, the proportion of cases resulting in post-dural puncture headache, and the incidence of failed labor analgesia.ResultsBaseline characteristics such as age, body mass index and parity were similar between the two groups. Among the 236 cases of inadvertent dural puncture, 173 women (73%) had an intrathecal catheter placed while 63 women (27%) had the epidural catheter resited. Comparing intrathecal with epidural catheters, there was no observed difference in the proportion of cases of prolonged second stage of labor (13% vs. 16%, P=0.57) and the overall rate of cesarean deliveries (17% vs. 16%, P=0.78). However, we observed a lower rate of post-dural puncture headache in women who had cesarean delivery compared to vaginal delivery (53% vs. 74%, P=0.007). A greater proportion of failed labor analgesia was observed in the intrathecal catheter group (14% vs. 2%, P=0.005).ConclusionThe choice of neuraxial technique following inadvertent dural puncture does not appear to alter the course of labor and delivery. Cesarean delivery decreased the incidence of post-dural puncture headache by 35%. Intrathecal catheters were associated with a higher rate of failed analgesia. |
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| Keywords: | Dural puncture Epidural analgesia Intrathecal catheter Cesarean delivery Postdural puncture headache |
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