title: Complications of 761 short-term intrathecal macrocatheters in obstetric patients: a retrospective review of cases over a 12-year period.
abstract: BACKGROUND
  A continuous spinal catheter is a reliable alternative to standard neuraxial techniques in obstetric anesthesia. Despite the potential advantages of intrathecal catheters, they remain underutilized due to fear of infection, nerve damage or post-dural puncture headache. In our tertiary care center, intrathecal catheters are either placed intentionally in high-risk obstetric patients or following inadvertent dural puncture using a 19-gauge macrocatheter passed through a 17-gauge epidural needle.
  
  
  METHODS
  A retrospective review of 761 intrathecal catheters placed from 2001 to 2012 was conducted. An institutional obstetric anesthesia database was used to identify patients with intrathecal catheters. Medical records were reviewed for procedural details and complications.
  
  
  RESULTS
  There were no serious complications, including meningitis, epidural or spinal abscess, hematoma, arachnoiditis, or cauda equina syndrome, associated with intrathecal catheters. The failure rates were 2.8% (3/108) for intentional placements and 6.1% (40/653) for placements following accidental dural puncture. The incidence of post-dural puncture headache was 41% (312/761) and the epidural blood patch rate was 31% (97/312).
  
  
  CONCLUSIONS
  This review demonstrates that intrathecal catheters are dependable and an option for labor analgesia and surgical anesthesia for cesarean delivery. Serious long-lasting complications are rare.
authors.affiliation: University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA. Electronic address: jhochman@med.miami.edu.
authors.forename: J
authors.initials: J
authors.lastname: Cohn
authors.affiliation: University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.
authors.forename: D
authors.initials: D
authors.lastname: Moaveni
authors.affiliation: University of Miami Public Health Sciences, Miami, FL, USA.
authors.forename: J
authors.initials: J
authors.lastname: Sznol
authors.affiliation: University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.
authors.forename: J
authors.initials: J
authors.lastname: Ranasinghe
mesh_terms: D000293:Adolescent; D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects* / Q000295:instrumentation; D000773:Anesthesia, Obstetrical / Q000009:adverse effects* / Q000295:instrumentation; D017217:Blood Patch, Epidural; D057785:Catheters / Q000009:adverse effects*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D051299:Post-Dural Puncture Headache / Q000453:epidemiology; D011247:Pregnancy; D012131:Respiratory Insufficiency / Q000139:chemically induced; D012189:Retrospective Studies
keywords: Continuous spinal catheter; Intrathecal catheter; Labor pain; Obstetric anesthesia