Document Detail

Intrathecal catheter insertion during labour reduces the risk of post-dural puncture headache.
MedLine Citation:
PMID:  9466026     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To describe the anaesthetic management and report the incidence of PDPH in three parturients who had experienced accidental dural puncture during labour and the subsequent deliberate intrathecal insertion of an epidural catheter. CLINICAL FEATURES: Inadvertent dural puncture with a 16-gauge Tuohy needle occurred during the first stage of labour at 3-4 cm cervical dilatation in all three women. The 20-gauge epidural catheter was immediately inserted into the subarachnoid space after accidental dural penetration. Intermittent intrathecal injections of lidocaine or bupivacaine with fentanyl were administered to provide analgesia during labour and delivery. Two of the women had spontaneous vaginal deliveries, whereas Caesarean section was performed in one case due to acute fetal distress during the second stage of labour. The intrathecal catheter was left in-situ for 13-19 hr after delivery and the women were questioned daily for symptoms of PDPH. None of the three women developed PDPH after dural puncture and intrathecal catheterisation with the epidural catheter. CONCLUSION: Immediate intrathecal insertion of the epidural catheter after accidental dural puncture during labour proved to be an effective prophylactic technique to prevent PDPH in these three parturients.
K C Dennehy; O P Rosaeg
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthésie     Volume:  45     ISSN:  0832-610X     ISO Abbreviation:  Can J Anaesth     Publication Date:  1998 Jan 
Date Detail:
Created Date:  1998-03-19     Completed Date:  1998-03-19     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  CANADA    
Other Details:
Languages:  eng     Pagination:  42-5     Citation Subset:  IM    
Department of Anaesthesia, Ottawa Civic Hospital, University of Ottawa, Ontario, Canada.
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MeSH Terms
Analgesia, Epidural / adverse effects*,  instrumentation
Analgesia, Obstetrical / adverse effects*,  instrumentation
Analgesics, Opioid / therapeutic use
Anesthetics, Local / therapeutic use
Bupivacaine / therapeutic use
Catheterization / instrumentation*
Cesarean Section
Delivery, Obstetric
Dura Mater / injuries
Fentanyl / therapeutic use
Headache / prevention & control*
Injections, Spinal / instrumentation*
Labor Stage, First
Labor, Obstetric*
Lidocaine / therapeutic use
Needles / adverse effects
Risk Factors
Spinal Puncture / adverse effects*,  instrumentation
Time Factors
Reg. No./Substance:
0/Analgesics, Opioid; 0/Anesthetics, Local; 137-58-6/Lidocaine; 2180-92-9/Bupivacaine; 437-38-7/Fentanyl
Comment In:
Can J Anaesth. 1998 Jan;45(1):6-9   [PMID:  9466019 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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