title: Lower incidence of post-dural puncture headache with spinal catheterization after accidental dural puncture in obstetric patients.
abstract: BACKGROUND
  Accidental dural puncture (ADP) and post-dural puncture headache (PDPH) are important complications of obstetric regional anesthesia. Inserting the catheter intrathecally after ADP to prevent PDPH has gained popularity. Nonetheless, data on the effect of an intrathecal catheter on PDPH and epidural blood patch (EBP) rates are mixed. Our primary objective was to examine if spinal catheterization reduces the incidence of PDPH after ADP in obstetric patients.
  
  
  METHODS
  Anesthetic records of 29,749 regional blocks performed between January 1997 and July 2013 were analyzed retrospectively. In all blocks containing an epidural component, 18-gauge epidural needles were used. All patients who experienced a witnessed ADP or PDPH without ADP were identified. Data from patients with or without a prolonged spinal catheter were compared.
  
  
  RESULTS
  There were 128 events of witnessed ADP (0.43%). Following known ADP, 39 women had an epidural catheter placed at a different level and 89 had an intrathecal catheter (20-gauge) for at least 24 h. Sixty-one patients developed PDPH after observed ADP (48%). Prolonged intrathecal catheter placement significantly reduced the incidence of PDPH after ADP to 42% compared with 62% in those who have the catheter re-sited epidurally [odds ratio = 2.3 (95% confidence interval 1.04-4.86); P = 0.04].
  
  
  CONCLUSIONS
  The incidence of ADP, PDPH and blood patching is similar with previously published studies. After witnessed ADP, inserting the epidural catheter intrathecally significantly reduced the incidence of PDPH.
authors.affiliation: Department of Anesthesiology, University Hospitals Gasthuisberg, Leuven, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Verstraete
authors.forename: M A
authors.initials: MA
authors.lastname: Walters
authors.forename: S
authors.initials: S
authors.lastname: Devroe
authors.forename: E
authors.initials: E
authors.lastname: Roofthooft
authors.forename: M
authors.initials: M
authors.lastname: Van de Velde
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D017217:Blood Patch, Epidural / Q000706:statistics & numerical data; D002404:Catheterization / Q000379:methods*; D036861:Delivery, Obstetric; D004388:Dura Mater / Q000293:injuries*; D004824:Epidural Space; D005260:Female; D006801:Humans; D051299:Post-Dural Puncture Headache / Q000453:epidemiology*; D011247:Pregnancy; D013131:Spine; D055815:Young Adult