title: Technique that better localizes the dura mater during intrathecal catheterization should reduce inadvertent multiple dural punctures and reduce complications.
abstract: We present here a technique to mitigate the complication of multiple needle entries into the thecal sac when attempting to place an intrathecal catheter into the thecal sac. Our technique of injecting radio-opaque contrast material after entering the epidural space and before entering the thecal sac allows for visualization of the thecal sac within the spinal canal, thus obviating the technique of "fell and pop" to enter the sac. In our hands, this technique has improved outcomes for our patients and has decreased the incidence of post dural puncture headache, neural trauma and technical failures.
authors.affiliation: Institute for Restorative Health, Davis, CA, USA, and              †Pacific Pain Treatment Centers, San Francisco, CA, USA.
authors.forename: Kayvan
authors.initials: K
authors.lastname: Haddadan
authors.forename: Elliot S
authors.initials: ES
authors.lastname: Krames