Decreased incidence of headache after accidental dural puncture in caesarean delivery patients receiving continuous postoperative intrathecal analgesia.
To examine the effects of prolonged (> 24 h) intrathecal catheterization with the use of postoperative analgesia on the incidence of post-dural puncture headache (PDPH), charts of 45 obstetric patients who had accidental dural puncture following attempts at epidural block were reviewed retrospectively. Three groups were identified: Group I (n = 15) patients had a dural puncture on the first attempt at epidural block, but successful epidural block on a repeated attempt; Group II (n = 17) patients had a dural puncture with immediate conversion to continuous spinal anaesthesia with catheterization lasting only for the duration of caesarean delivery; Group III (n = 13) patients had an immediate conversion to spinal anaesthesia and received post-caesarean section continuous intrathecal patient-controlled analgesia consisting of fentanyl 5 micrograms.ml-1 with bupivacaine 0.25 mg.ml-1 and epinephrine 2 micrograms.ml-1 with catheterization lasting > 24 h. No parturient in group III developed a PDPH. This was substantially lower (P < 0.009) than the 33% incidence for group I and the 47% incidence for group II. The incidence of a PDPH did not differ between group I and II. Similarly, there was no difference between group I and II with regard to requests for a blood patch. Patients receiving continuous intrathecal analgesia had excellent pain relief, could easily ambulate and none complained of pruritus, nausea, vomiting, sensory loss or weakness. In conclusion, indwelling spinal catheterization > 24 h with continuous intrathecal analgesia following accidental dural puncture in parturients may for some patients be a suitable method for providing PDPH prophylaxis and postoperative analgesia.
Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY.
S
S
Cohen
D
D
Amar
E J
EJ
Pantuck
N
N
Singer
M
M
Divon
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D016058:Analgesia, Patient-Controlled; D017217:Blood Patch, Epidural; D002045:Bupivacaine; D002585:Cesarean Section; D004837:Epinephrine; D005260:Female; D005283:Fentanyl; D006261:Headache / Q000209:etiology* / Q000628:therapy; D006801:Humans; D010149:Postoperative Pain / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies; D013129:Spinal Puncture / Q000009:adverse effects*
D005283:Fentanyl; D002045:Bupivacaine; D004837:Epinephrine