///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

Intrathecal catheters for the prevention of postdural puncture headache after inadvertent dural puncture: a retrospective database analysis

Abstract Number: 211
Abstract Type: Original Research

Thomas J Van de Ven MD, PhD1 ; Mercy Udoji MD2; Ashraf S Habib MBB3

Intrathecal catheters for the prevention of postdural puncture headache after inadvertent dural puncture: a retrospective database analysis

Background and Objectives:

Postdural puncture headache (PDPH) after inadvertent dural puncture with an 18g Tuohy needle appears to have an incidence of about 50%1. While some studies have shown a benefit of placing an intrathecal catheter by reducing the incidence of headache 2,3, others did not confirm those findings4,5. We therefore performed a retrospective analysis of patients with obvious dural puncture at the time of labor epidural placement to determine whether the placement of a subarachnoid catheter at the time of puncture reduces the incidence of PDPH or the need for epidural blood patch (EBP).

Methods: We searched our PDPH quality improvement database for patients who had inadvertent dural punctures during labor epidural placement. This database includes details about the follow up and management of all patients who sustained an inadvertent dural puncture or who developed a headache with a postural component during the postpartum period. These patients were divided into two groups - those who received a subarachnoid catheter at the time of puncture and those who did not. The incidence of PDPH and the need for EBP was compared between the groups.

Results: We found 122 patients with obvious unintentional dural puncture with an 18 G Tuohy needle during epidural or combined spinal epidural placement over the course of 10 years. The overall incidence of PDPH for all patients with obvious dural puncture was 65.6%. Of those, 69 patients had a 20 G intrathecal catheter placed at the time of attempted epidural placement. The intrathecal catheter was left for a mean (SD) of 14.8 (9.4) hours after the dural puncture. There was no difference in age or BMI between the two groups. There was a trend for a lower incidence of PDPH in patients who had the intrathecal catheter (p=0.055). However the percentage of patients who received an EBP was not different between the two groups. (table).

Conclusion: Placement of a subarachnoid catheter at the time of dural puncture might reduce the incidence of PDPH in women who suffer an inadvertent dural puncture at the time of labor epidural placement. Prospective randomized studies are needed to confirm those findings.

Spinal Catheter No Spinal Catheter p value

n=69 n=53

PDPH 40 (58.0%) 40 (75.7%) 0.06

EBP 19 (27.5%) 19 (35.8%) 0.33

Data are number (%)

SOAP 2009