International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2001
Management of accidental dural puncture in labour with intrathecal catheters: an analysis of 10 years' experience.
The records of 15030 labour epidural blocks were analysed. Seventy-two accidental dural punctures (ADP) were recognised at the time of the procedure. In 34 women an epidural catheter was inserted intrathecally through the Tuohy needle and continuous spinal analgesia provided. ⋯ Epidural blood patch was performed on 50% of women managed with intrathecal catheters compared with 73% of those managed without (P = 0.08). Following ADP in labour an intrathecal catheter is a simple and effective alternative to resiting an epidural. Recognition of ADP is important as it allows appropriate management avoiding possible complications of administering epidural top-ups in the presence of a dural tear.
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Int J Obstet Anesth · Jul 2001
Randomized Controlled Trial Clinical TrialEffect of lateral versus supine wedged position on development of spinal blockade and hypotension.
Aortocaval compression may not be completely prevented by the supine wedged or tilted positions. It is commonly believed, however, that the unmodified full lateral position after induction of spinal anaesthesia might allow excessive spread of the block. We therefore compared baseline arterial pressures in the supine wedged, sitting, tilted and full lateral positions in 40 women who were about to undergo elective caesarean section. ⋯ Following spinal anaesthesia, hypotension (defined as a reading
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Int J Obstet Anesth · Jul 2001
Complications with 25-gauge and 27-gauge Whitacre needles during combined spinal-epidural analgesia in labor.
Needle size and shape may influence the incidence of paresthesias, post-dural puncture headache and other complications during combined spinal-epidural (CSE) procedures. We have noted a relatively high incidence of transient paresthesias during placement of the spinal needle during CSE for labor analgesia. The purpose of this study was to compare the occurrence of paresthesia and post-dural puncture headache in parturients who received CSE analgesia with either a 25-gauge or 27-gauge Whitacre needle. ⋯ Incidence, duration, and character of any paresthesias upon spinal needle placement and the incidence and treatment of headache were recorded. The incidence of paresthesia with the two needles was similar (16% with 25-gauge vs 15.4% with 27 gauge) but the incidence of post-dural puncture headache was higher with the 25-gauge needle (4% vs 0.7% with 27 gauge, P < 0.05). Our data suggest that with Whitacre needles, 27-gauge might be preferable to 25-gauge needles to reduce the rate of post-dural puncture headache in parturients but that they do not alter the incidence of transient paresthesias.
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Int J Obstet Anesth · Jul 2001
An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients.
We report a prospective audit of 100 parturients who experienced accidental dural puncture by a Tuohy needle, while attending a tertiary referral obstetric unit during the period 1993-1999. The post dural puncture headache rate was 81% and the diagnosis of dural puncture was delayed until presentation of the headache in 27% of these cases. The incidence of unrecognised dural puncture was not influenced by the technique used for identification of the epidural space. ⋯ There was a trend to earlier onset of headache (either immediate or within 24 h) when the epidural identification technique was loss-of-resistance to air rather than saline (54% versus 33%, P = 0.07). Twenty-eight percent of those suffering from post dural puncture headache were treated expectantly and 72% received a therapeutic blood patch. Of seven parturients who received sumatriptan, six found it ineffective and five subsequently received a blood patch.
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Int J Obstet Anesth · Jul 2001
An audit of epidural blood patch after accidental dural puncture with a Tuohy needle in obstetric patients.
We report the results of a prospective audit of accidental dural puncture in 100 obstetric patients in a single tertiary referral institution during the period 1993 to 1999. The post dural puncture headache rate was 81%. Of the 81 parturients with post dural puncture headache, 58 (72%) received a therapeutic epidural blood patch, using 7 to 25 mL of autologous blood. ⋯ There was no significant association between volume of blood used for blood patch and success rate. The initial rate of resolution of headache did not differ significantly between parturients receiving a blood patch within 48 h of dural puncture and after 48 h (P =0.70). However, in the former group, the incidence of recurrent headache was significantly higher (59% versus 11%, P<0.001).