Inadvertent Dural Puncture During Labor Epidural Placement
Abstract Number: 198
Abstract Type: Original Research
Purpose: The placement of epidural catheters for labor analgesia is common in anesthetic practice yet not without risks and complications, particularly inadvertent puncture of the dura (IDP). To date there are no clear guidelines for the management of IDP. This survey was an attempt to determine the usual practice for managing IDP among Ottawa anesthesiologists and residents.
Methods: 121 anesthesiologists and residents at the Ottawa Civic and General Hospitals were invited to participate in an on-line survey. Ethics approval was sought but deemed unnecessary. Survey questions were aimed at understanding usual practice when IDP was encountered, what medications were used and how potential postdural puncture headache (PDPH) was managed as well as an attempt to elucidate the reason behind such actions. The final question asked whether a protocol for managing IDP would be desirable.
Results: 66% of staff and 90% of residents responded to the survey (76% overall). There were no statistical differences between staff and resident responses. When faced with an IDP, both groups were almost equal in choosing to resite the epidural at a different level or to use an intrathecal catheter. Reasons for resiting were related to lack of experience with intrathecal catheters or concerns regarding their safety. Potential PDPH was generally managed by conservative measures followed by blood patch after 48 hours. An interest in developing a protocol to assist in management of inadvertent dural puncture was expressed by the majority of respondents.
Conclusions: Residents and staff differ little in their management of IDP. There is little evidence to support either choice and the most appropriate management may in fact depend on the clinical situation at the time of attempted epidural placement. The knowledge deficit identified by respondents surrounding the use of intrathecal catheters could be easily rectified thus offering an additional modality of effective labor analgesia to parturients. Protocols have been shown internationally to be a useful componenet of managing IDP although flexible guidelines may be a more option acceptable to this group of professionals.
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