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Complications of Continuous Intrathecal Catheters in Obstetric Patients
Abstract Number: O1 6
Abstract Type: Original Research
Our institution takes care of a significant number of high risk obstetric patients. Therefore, it is a common practice to place intrathecal (IT) catheters in these patients (morbidly obesity, significant pulmonary/cardiac disease, difficult epidural catheter placement), or following accidental dural puncture (ADP).
After IRB approval, the medical records of all obstetric patients undergoing IT catheter placements from 2001 to 2012 were retrospectively identified from the Anesthesiology Quality Database and Medical records. The intrathecal catheters were placed for vaginal or cesarean delivery using 17G Tuohy needle and 20 G epidural catheters.
A total of 761 patients had Intrathecal (IT) catheter placements during the study period. This included 110 intentional IT catheter placements and 651 accidental dural punctures (ADP group). Out of the 651 catheters, 634 catheters were placed intrathecally after noticing the dural punctures. The rest of the catheters (17) were presumed to be placed epidurally and later discovered to be intrathecal.
Over half (51%) of the 111 intentional catheters were placed due to morbid obesity (BMI 38-81 kg/m2). About 25% were placed following difficult epidural catheter placements or failed epidural catheters. The reason was not documented in 8% of patients (9). The rest of the catheters (17%) were placed in patients with significant cardiac, pulmonary disease, or anatomical abnormalities involving the spine.
Catheter Failures: A total of 45 IT catheters failed in this study. Therefore, the overall failure rate of IT catheters was 5.9% (45/761). The failure rate was 7.1 % in the intentional group (8) and 5.7% in the ADP group (37).
Respiratory Problems: Four patients in the ADP group had high block requiring intubation and ventilation.
Post dural puncture headache (PDPH): There were 312 patients (40.9%) who developed PDPH. Out of these 99 patients (31%) required epidural blood patch treatment. Therefore the epidural blood patch incidence was 13% (99/761).
Neurological problems: There were no cases of meningitis, arachnoiditis, cauda equina syndrome or epidural hematoma identified in this series. However, three patients from the ADP group did present with postpartum headache initially attributed to PDPH, but they were later diagnosed with neurological conditions unrelated to IT catheter placement.
Intrathecal catheters are infrequently used in the obstetric patients due to fear of complications such as post dural puncture headache (PDPH), or more severe complications such as infection and neurological damage. However, no infections or neurological damage occurred in this series. Since IT catheter use can be an attractive option for parturients with certain comorbities, the relative risk of PDPH, which is a treatable condition, should be weighed against the many advantages of this neuraxial technique.