title: Factors related to accidental dural puncture in epidural anesthesia patients.
abstract: OBJECTIVE
  Accidental dural puncture (ADP) is known as a complication of epidural anesthesia. Although puncture site and advanced age have been reported to increase the risk of ADP, all related factors have not been fully investigated. We retrospectively investigated factors related to ADP in patients undergoing surgery.
  
  
  METHODS
  We reviewed the records of 4107 patients who received epidural anesthesia or combined spinal-epidural anesthesia from April 2010 to March 2013 at our institution. We defined ADP as cases in which cerebrospinal fluid was obviously discharged during puncture and excluded cases in which the epidural catheter was suspected to be inserted into subarachnoid space. We investigated patient background including age, sex, height, body weight, body mass index, vertebral level of puncture site, and presence of ADP, with Student t test, a χ(2) test, and multivariable logistic regression analysis used for statistical tests and significance set at P < .05.
  
  
  RESULTS
  Twenty (0.49%) of our patients had ADP. Factors significantly associated were punctures in the 10th-12th thoracic intervertebral (P = .01; odds ratio [OR], 5.19; 95% confidential interval [95% CI], 1.41-19.14) and first to third lumbar intervertebral (P = .03; OR, 5.45; 95% CI, 1.23-24.12) spaces and age (per 1-year increase, P < .01; OR, 1.04; 95% CI, 1.01-1.07).
  
  
  CONCLUSIONS
  Accidental dural puncture occurred in 0.49% of all surgical patients undergoing epidural anesthesia and was significantly related to those who received a puncture in lower thoracic and lumbar intervertebral spaces, whereas age was also an independent factor.
authors.affiliation: Department of Anesthesiology and Intensive Care, Hiroshima University Hospital, Hiroshima, Japan. Electronic address: kojiro.kuroda@gmail.com.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Kuroda
authors.affiliation: Department of Anesthesiology and Intensive Care, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Miyoshi
authors.affiliation: Department of Anesthesiology and Intensive Care, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kato
authors.affiliation: Department of Anesthesiology and Intensive Care, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Nakamura
authors.affiliation: Department of Anesthesiology and Intensive Care, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Toshimichi
authors.initials: T
authors.lastname: Yasuda
authors.affiliation: Department of Anesthesiology and Intensive Care, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Oshita
authors.affiliation: Department of Anesthesiology and Intensive Care, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Saeki
authors.affiliation: Department of Anesthesiology and Intensive Care, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hamada
authors.affiliation: Department of Anesthesiology and Intensive Care, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kawamoto
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D002404:Catheterization / Q000009:adverse effects*; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013904:Thoracic Vertebrae
keywords: Accidental dural puncture; Epidural anesthesia; Related factor