title: Accidental dural puncture: combination of prophylactic methods to avoid post-dural puncture headache.
abstract: Accidental dural puncture (ADP) is a common complication of epidural catheter insertion, and may lead to post-dural puncture headache (PDPH), especially in obstetric patients. Epidural blood patch (BP) is the most effective treatment of PDPH. Prophylactic BP has shown its efficacy to prevent PDPH; nevertheless, this method may be insufficient. We report an ADP case before induction of labor in a 28-year-old parturient. To avoid PDPH, an intrathecal catheter was immediately inserted after ADP and an epidural catheter was also inserted at the interspace above. Catheters were kept in place for more than 24hours. A prophylactic BP was performed immediately after removal of the intrathecal catheter. The patient did not experience any headache. This combination of treatments (intrathecal catheter insertion+prophylactic BP) may be a good alternative approach to prevent PDPH, even if it has to be warranted by other clinical studies.
authors.affiliation: Département d'anesthésie et réanimation, CHU de Toulouse, université Paul Sabatier, hôpital Purpan, place du Dr-Baylac, 31059 Toulouse cedex 9, France. Electronic address: julie.gobin@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Gobin
authors.affiliation: Département d'anesthésie et réanimation, CHU de Toulouse, université Paul Sabatier, hôpital Purpan, place du Dr-Baylac, 31059 Toulouse cedex 9, France.
authors.forename: L
authors.initials: L
authors.lastname: Lonjaret
authors.affiliation: Département d'anesthésie et réanimation, CHG d'Albi, 22, boulevard Général-Sibille, 81000 Albi, France.
authors.forename: A
authors.initials: A
authors.lastname: Pailhas
authors.affiliation: Département d'anesthésie et réanimation, CHU de Toulouse, université Paul Sabatier, hôpital Purpan, place du Dr-Baylac, 31059 Toulouse cedex 9, France.
authors.forename: F
authors.initials: F
authors.lastname: Bayoumeu
authors.affiliation: Département d'anesthésie et réanimation, CHU de Toulouse, université Paul Sabatier, hôpital Purpan, place du Dr-Baylac, 31059 Toulouse cedex 9, France.
authors.forename: V
authors.initials: V
authors.lastname: Minville
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D017217:Blood Patch, Epidural; D002404:Catheterization / Q000009:adverse effects; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D005317:Fetal Growth Retardation / Q000473:pathology; D006801:Humans; D019635:Neurosurgical Procedures / Q000009:adverse effects; D051299:Post-Dural Puncture Headache / Q000517:prevention & control*; D011247:Pregnancy
keywords: Accidental dural puncture; Blood patch; Brèche durale accidentelle; Cathéter intrathécal; Céphalées post-brèche durale; Epidural blood patch; Intrathecal catheter; Post-dural puncture headache