Canadian Journal of Anesthesia, Vol 45, 110-114, Copyright © 1998 by Canadian Anesthesiologists' Society

ARTICLES

North American survey of the management of dural puncture occurring during labour epidural analgesia

CW Berger, ET Crosby and W Grodecki
Department of Anaesthesia, University of Ottawa, Ottawa General Hospital, Ontario.

PURPOSE: To document the range and the most common strategies for the management of the parturient with inadvertent dural puncture (DP) during labour epidural analgesia. METHODS: A confidential survey form was mailed to 46 academic units in Canada and USA. The responses were compiled into Canadian, US and joint North American databases. RESULTS: Thirty-six centres (78%) responded, representing 137,250 annual deliveries. The reported incidence of DP was 0.04-6%. The most common initial response to DP was resiting the catheter at another level. Most centres made little change in routine practice regarding epidural top-ups and infusion rates after DP. Unrestricted mobilisation was advocated by 86% of centres following delivery; enhanced oral hydration was encouraged by 61%. Prophylactic epidural blood patch (PEBP) was recommended by 37% of centres, with twice as many US as Canadian centres doing so. In the presence of PDPH, EBP was offered most commonly at or within 24 hr of diagnosis. Complications were common after EBP: 86% of centres reported patch failures; 44% reported persistent headache after > or = 2 EBP. Despite this, centres remained optimistic about EBP success, quoting cure rates > 90% in 58% of centres. CONCLUSION: There is little difference between the practices reported by Canadian or US centres. The expressed optimism regarding the efficacy of EBP is not supported by the evidence available and may be unwarranted. More research is needed to define the issue better.

This article has been cited by other articles:

				P. K. Morley-Forster, S. Singh, P. Angle, J. Littleford, M. Currin, and S. H. Halpern The effect of epidural needle type on postdural puncture headache: a randomized trial: [L'effet du type d'aiguille de peridurale sur les cephalees post-ponction durale : une etude randomisee]. Can J Anesth, June 1, 2006; 53(6): 572 - 578. [Abstract] [Full Text] [PDF]

				P. Angle, S. L. T. Tang, D. Thompson, and J. P. Szalai Expectant management of postdural puncture headache increases hospital length of stay and emergency room visits: [Le traitement symptomatique de la cephalee post-ponction durale augmente la duree du sejour hospitalier et les visites a la salle d'urgence] Can J Anesth, April 1, 2005; 52(4): 397 - 402. [Abstract] [Full Text] [PDF]

				C. P. Bleeker, I. M. Hendriks, and L. H. D. J. Booij Postpartum post-dural puncture headache: is your differential diagnosis complete? Br. J. Anaesth., September 1, 2004; 93(3): 461 - 464. [Abstract] [Full Text] [PDF]

				R. Sharma, A. Bailey, J. Bamber, and D. K. Turnbull Post-dural puncture headache Br. J. Anaesth., March 1, 2004; 92(3): 449 - 450. [Full Text] [PDF]

				D. K. Turnbull and D. B. Shepherd Post-dural puncture headache: pathogenesis, prevention and treatment Br. J. Anaesth., November 1, 2003; 91(5): 718 - 729. [Abstract] [Full Text] [PDF]

				B. Chiron, M. Laffon, M. Ferrandiere, and J.-F. Pittet Postdural puncture headache in a parturient with sickle cell disease: use of an epidural colloid patch: [Cephalees post ponction durale chez une parturiente drepanocytaire : injection peridurale de colloide] Can J Anesth, October 1, 2003; 50(8): 812 - 814. [Abstract] [Full Text] [PDF]

				J. P. R. Loughrey, S. Eappen, and L. C. Tsen Spinal Anesthesia for Cesarean Delivery Shortly After an Epidural Blood Patch Anesth. Analg., February 1, 2003; 96(2): 545 - 547. [Abstract] [Full Text] [PDF]

				T. Ezri, E. Abouleish, C. Lee, and S. Evron Intracranial subdural hematoma following dural puncture in a parturient with HELLP syndrome: [Hematome sous-dural intracranien post-ponction durale chez une parturiente atteinte du syndrome HELLP] Can J Anesth, October 1, 2002; 49(8): 820 - 823. [Abstract] [Full Text] [PDF]

				J. L. Hawkins Maternal morbidity and mortality: anesthetic causes Can J Anesth, June 1, 2002; 49(90001): R6 - 6. [Full Text] [PDF]

				A. Cyna and C. Seifert Inadvertent dural puncture BMJ, May 13, 2000; 320(7245): 1338 - 1338. [Full Text]

				J. S. Anwari, P. Duffy, and E. T. Crosby Epidural Blood Patch (EBP) and septic complication Can J Anesth, March 1, 2000; 47(3): 289 - 290. [Full Text] [PDF]

				V. Souron and J. Hamza Treatment of Postdural Puncture Headaches with Colloid Solutions: An Alternative to Epidural Blood Patch Anesth. Analg., November 1, 1999; 89(5): 1333 - 1333. [Full Text] [PDF]

				A. Sharma, E. Williams, W. Fawcett, G. Jenkins, C. Sudlow, M G Serpell, G J Haldane, D R S Jamieson, and D Carson Preventing headache after lumbar puncture BMJ, December 5, 1998; 317(7172): 1588a - 1588. [Full Text]