title: Immediate management of inadvertent dural puncture during insertion of a labour epidural: a survey of Australian obstetric anaesthetists.
abstract: Immediate management of inadvertent dural puncture during insertion of an epidural needle during labour is controversial and evidence to guide clinical practice is limited. We surveyed Australian obstetric anaesthetists by anonymous postal questionnaire. Of the 671 surveys sent, 417 (62%) were returned. Following dural puncture, 265 respondents (64%) indicated that they "would usually remove the Tuohy needle and resite". The most common reason for this decision was concern regarding the safety of intrathecal catheters (ITC) (n = 236, 89%), in particular, the risk of misuse (n = 182, 70%). The most frequently reported reason for "usually inserting an ITC" was that this reduced the incidence (n = 120, 84%) and severity (n = 110, 77%) of post dural puncture headache. Increased frequency of ITC insertion was reported by respondents who practised more frequent sessions of obstetric anaesthesia, had fewer years of experience as a consultant anaesthetist and worked in a public hospital. The more widespread use of ITCs seems to be limited by safety concerns.
authors.affiliation: Department of Women's Anaesthesia, Women's and Children's Hospital, Adelaide, South Australia, Australia.
authors.forename: M J
authors.initials: MJ
authors.lastname: Newman
authors.forename: A M
authors.initials: AM
authors.lastname: Cyna
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000295:instrumentation; D016362:Analgesia, Obstetrical / Q000009:adverse effects* / Q000295:instrumentation; D000776:Anesthesiology / Q000379:methods / Q000592:standards; D001315:Australia; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006801:Humans; D007278:Injections, Spinal / Q000009:adverse effects / Q000295:instrumentation; D007743:Labor, Obstetric; D019300:Medical Errors; D009339:Needles / Q000009:adverse effects; D051299:Post-Dural Puncture Headache / Q000209:etiology / Q000517:prevention & control; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011247:Pregnancy; D013021:South Australia; D013129:Spinal Puncture / Q000009:adverse effects* / Q000295:instrumentation