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INTRATHECAL CATHETER AND EPIDURAL BLOOD PATCH IN ACCIDENTAL DURAL PUNCTURE
ESRA Academy. Rana M. Sep 8, 2016; 138442; 0292 Topic: Epidural Anaesthesia - Analgesia
Disclosure(s): NONE
Dr. Munawar Rana
Dr. Munawar Rana

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Abstract
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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.

Methods:

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.

Results:

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).

Conclusions:

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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