Intrathecal catheterization after unintentional dural puncture during orthopedic surgery.
OBJECTIVE
We investigated whether inserting an intrathecal catheter and leaving it in place for 24 h after an unintentional dural puncture in orthopedic patients reduced the incidence of post-dural puncture headache (PDPH).


METHODS
The study consisted of 427 patients in whom a total of 21 unintentional dural punctures had occurred during orthopedic surgery performed between 2002 and 2006. Seven patients (phase I; evaluated retrospectively) each underwent placement of an epidural catheter at another level after dural puncture during the period January 2002 to February 2004. Fourteen patients (phase II; evaluated prospectively) received an epidural catheter through the dural tear after an unintentional dural puncture during the period February 2004-March 2006


RESULTS
In phase I, 5 of the 7 patients experienced PDPH, and one required an epidural blood patch. In phase II, only one of the 14 patients complained of PDPH, which resolved after 48 h of medical therapy. No patient experienced paresthesia, neurologic or hemorrhagic complication, or infection.


CONCLUSIONS
Inserting an epidural catheter through the dural tear following an unintentional dural puncture and leaving it in place for 24 h significantly reduces the incidence of PDPH.
Turkoz
Ayda
A
Department of Anesthesiology, Baskent University Adana Teaching and Medical Research Center, Adana, Turkey. aydaturkoz@yahoo.com
Kocum
Aysu
A
Eker
H Evren
HE
Ulgen
Hacer
H
Uysalel
Mustafa
M
Arslan
Gulnaz
G
D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D002404:Catheterization; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D019637:Orthopedic Procedures; D051299:Post-Dural Puncture Headache / Q000517:prevention & control*; D011184:Postoperative Period; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013115:Spinal Canal; D013997:Time Factors