The management of accidental dural puncture

Abstract

I read with interest the recent article by Baraz and Collis [1] discussing the management of accidental dural puncture during labour epidural analgesia in the United Kingdom. The authors are to be congratulated for conducting such an interesting and clinically useful survey of current management of this complication. In my practice of obstetric anaesthesia at the University of California, San Diego, accidental dural puncture is followed by injection of the CSF in the glass syringe back into the subarachnoid space through the epidural needle, insertion of a epidural catheter into the subarachnoid space, injection of a small amount of preservative free saline (3–5 ml) into the subarachnoid space through the intrathecal catheter, administration of a bolus and then continuous subarachnoid labour analgesia, and leaving the catheter in situ in the subarachnoid space for a total of 12–20 h [2, 3]. These five manoeuvers decreased the incidence of epidural needle-induced, postdural puncture headache in parturients following dural puncture with a large bore (for example 18 G) epidural needle from the textbook-referenced 76–85%[4] to 6.6%[3].