Abstract
This study aimed to determine whether insertion of an intrathecal catheter following accidental dural puncture (ADP) in obstetric patients can reduce the incidence of post-dural puncture headache (PDPH) and the requirement of a therapeutic epidural blood patch (TEBP). This was also compared with relocating the epidural catheter at a different vertebral interspace. A retrospective study was performed, as well as a meta-analysis of the literature to further validate our findings. We reviewed the records of 86 obstetric patients who suffered from ADP during epidural anesthesia or combined spinal-epidural anesthesia from October 2015 to November 2016 at our institution. Although, there was no significant decrease in the incidence of PDPH (P = 0.08), the requirement for a TEBP (P = 0.025) was significantly reduced in the intrathecal catheter group compared with the relocated group. In the meta-analysis, 13 eligible studies including 1044 obstetric patients were finally identified. To estimate the pooled risk ratios (RRs), fixed or random effect models were used depending on the heterogeneity. We initially found that an intrathecal catheter significantly reduced the incidence of PDPH (pooled RR = 0.823; 95% CI = 0.700–0.967; P = 0.018) and the requirement of a TEBP (pooled RR = 0.616; 95% CI = 0.443–0.855; P = 0.004). Our study shows that insertion of an intrathecal catheter following ADP might be an effective and dependable method for reducing the risk of a PDPH and requirement for a TEBP in obstetric patients.
Highlights
Neuraxial analgesia is the most effective and reliable technique for pain relief during labor, and is widely used in maternity units [1]
This study aimed to assess whether an intrathecal catheter could decrease the incidence of post-dural puncture headache (PDPH) and the requirement of a therapeutic epidural blood patch (TEBP) compared with relocating the catheter
There was no significant decrease in the incidence of PDPH (P = 0.08), the requirement for a TEBP (P = 0.025) was significantly reduced in the ITC group compared with the relocated group (Table 2)
Summary
Neuraxial analgesia is the most effective and reliable technique for pain relief during labor, and is widely used in maternity units [1]. Accidental dural puncture (ADP) is one of the most common complications of neuraxial anesthesia in labor, with an incidence between 0.19% and 3.6% [2]. Subsequent post-dural puncture headache (PDPH) develops in more than 50% of patients [3]. The clinical symptomatology of PDPH can destroy the joy of childbirth, hinder nursing the infants, prolong hospital stay, and increase costs, resulting in dissatisfaction of the experience of anesthesia.
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