ESRA Academy. Rana M. Sep 8, 2016; 138442; 0292 Topic: Epidural Anaesthesia - Analgesia
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Dr. Munawar Rana
Dr. Munawar Rana

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Background and Aims:

Post Dural Puncture Headache (PDPH) is a known serious complication of neuraxial anaesthesia. We looked into the impact of Intrathecal Catheter (ITC) placement on the subsequent need of having epidural blood patches (EBP) for PDPH management.


After approval from local ethics committee, a retrospective cohort study (2009-16) was conducted, to collect data on PDPH, ITC placement and EBP use, at a major obstetric hospital in South Australia. The primary outcome was to see if ITC placement post ADP had any impact on the need of having an EBP.


We included information on 92 ADP and 55 unintentional/intentional dural punctures (CSE/Spinals). We report that those who did not have an ITC placement post ADP were almost two times more likely to have an EBP than those who had an ITC placement (RR: 1.9, p value <0.01). Additionally we found that of the 55 unintentional unrecognized dural punctures during neuraxial procedures and intentional dural punctures (CSE/Spinals) 60% of the cases did not receive an EBP. ITC was placed in 64 cases with 37 (57.8%) placed for ≥24 hours and 21 (32.8%) placed for <24 hours. Among the 37 cases where ITC was placed for ≥24 hours after ADP obviated the need for EBP in 28 (75.7%) of the cases (Chi Sq. 8.8; df 1; p-value 0.004).


ITC placement in ADP can be both for ongoing analgesia and avoiding another potential procedure of re-siting epidural, potentially reducing PDPH incidence and reducing the need of an EBP significantly.

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