Subarachnoid catheter placement after wet tap for analgesia in labor: influence on the risk of headache in obstetric patients.
OBJECTIVE
The incidence of postdural puncture headache (PDPH) after epidural wet tap for obstetric patients may be as high as 75%. We have studied how subsequent placement of a subarachnoid catheter immediately after confirmation of a wet tap, and leaving the catheter in place for 24 hours affects the incidence of PDPH.


METHODS
Over a 5-year interval, 115 consecutive patients who had unintentional dural puncture were divided into 3 groups by consecutive assignment. Group A had an epidural catheter placed at another interspace. Group B had a subarachnoid catheter placed for labor analgesia that was removed immediately after delivery. Group C had a subarachnoid catheter that was left in place for 24 hours after delivery. Data were collected retrospectively. The incidence of PDPH and blood patch was compared between groups.


RESULTS
The overall incidence of PDPH was 46.9% and need for blood patch 36.5%, significantly less in both subarachnoid catheter groups, 31% in B and 3% in group C, compared with group A (PDPH 81%) (P <.001).


CONCLUSIONS
Subarachnoid catheter placement after wet tap in obstetric patients reduces the PDPH rate and does so to a greater extent if left in place for 24 hours after delivery.
Ayad
Sabry
S
Department of Anesthesiology, Fairview Hospital, Cleveland Clinic Health System, Cleveland, OH 44195, USA.
Demian
Yousef
Y
Narouze
Samer N
SN
Tetzlaff
John E
JE
D000328:Adult; D016362:Analgesia, Obstetrical / Q000009:adverse effects* / Q000379:methods; D000704:Analysis of Variance; D002404:Catheterization / Q000379:methods*; D005260:Female; D006261:Headache / Q000139:chemically induced* / Q000517:prevention & control; D006801:Humans; D007278:Injections, Spinal; D007743:Labor, Obstetric / Q000187:drug effects* / Q000502:physiology; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D013346:Subarachnoid Space / Q000187:drug effects* / Q000502:physiology