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

Management Strategies for Accidental Dural Puncture and Post-Dural Puncture Headache in North America: A Comprehensive Survey

Abstract Number: 23
Abstract Type: Original Research

Jason E Pope M.D.1 ; Curtis L Baysinger M.D.2; Ellen M Lockhart M.D.3; Nathaniel Mercaldo MS4; Jonathan Schildcrout PhD5

PURPOSE: The recognized incidence of accidental dural puncture (ADP) has been reported to be 1-3%1. Measures used to treat and prevent post dural puncture headache (PDPH) vary widely in surveys reported over a decade ago in North America and the United Kingdom (UK)2,3 with substantial changes in ADP management noted when repeated in the UK 4 years ago4. The purpose of this survey was to sample the current management strategies of ADP and PDPH.

METHODS: Following Institutional Review Board approval and permission by the Society for Obstetric Anesthesia and Perinatology SOAP Research Committee, an 83-item electronic survey was distributed to all members of SOAP. The questionnaire consisted of seven parts: respondent demographics, epidural catheter (EC) and intrathecal catheter (ITC) management after ADP, prophylactic and conservative measures to prevent and treat PDPH, epidural blood patch (EBP) management, and patient follow-up.

RESULTS: (Table 1): From the 1145 members of SOAP, 170 responses were collected (response rate = 170/1145 = 14:8%).Ten entries from non-North American countries were excluded. Of the remaining 160, 16 were from Canada and 144 from the United States. Of the 160 respondent zip codes, 104 occurred only once, 16 twice, and 2 four times. The rate of ADP was reported as unknown by 22.5% of respondents, and 0-2% by 61.3% of others. 86.2% reported no protocol for ADP management. 28% of North American practitioners never use an ITC after ADP, 6% always use an ITC after ADP. Resiting an epidural catheter after ADP is the most common practice. Common prophylactic and conservative treatment strategies for PDPH include hydration, caffeine, and PO opioids. 32% leave EC in place to reduce PDPH. Nearly 50% of respondents prescribe bed rest. A significant minority of practitioners feel that conservative Rx is mostly ineffective. EBPs are placed by over 50% of practitioners 13-24 hours after PDPH onset.

DISCUSSION: Protocols for ADP management are rare and rate of ADP is unknown for their practice among a significant minority of respondents. Wide variation in catheter management after ADP and measures used to prevent and treat PDPH reflect a lack of outcome studies to guide care.

REFERENCES:

1. Norris MC et.al. Reg Anesth 1990; 15: 285-7.

2. Berger, CW et.al. Can J Anesth 1998 45:2 p110-14.

3. Sajjad T et.al. Anaesthesia 1995; 50: 156-61.

4. Baraz R et.al. Anesthesia 1005; 60: 673 - 679.



SOAP 2009