• C M Cowan and E W Moore.
• Liverpool Women's Hospital and the Royal Liverpool University Hospital, Liverpool, UK. craig@cowan1970.freeserve.co.uk
• Int J Obstet Anesth. 2001 Jan 1;10(1):11-6.

AbstractFive hundred UK obstetric anaesthetists were surveyed to investigate retrospectively the relationship between experience, rotation of the epidural needle within the epidural space, choice of loss-of-resistance agent and accidental dural puncture (ADP) rate. Responses were received from 390 (78%) of the members surveyed. Anaesthetists with more than 15 years' experience are more likely to perform an epidural with the patient in the lateral position (P < 0.001), use loss-of-resistance to air to detect the epidural space (P < 0.001) and rotate the epidural needle after identifying the epidural space (P = 0.001) when compared to those of less experience. A reduced inadvertent dural puncture rate was found to be associated with increased frequency of performing the procedure (P = 0.012), greater experience of the practitioner (P = 0.049) and non-rotation of the epidural needle (P = 0.023). There are three components that can alter from case to case; patient positioning, loss-of-resistance agent and needle rotation. Loss-of-resistance agent and patient positioning in isolation did not significantly influence ADP rate. This study suggests that the combination of practising lateral patient positioning, loss-of-resistance to saline and non-rotation of the epidural needle significantly reduces ADP rate (P = 0.035).

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