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Evaluation of continuous spinal catheters in obstetric patients
Abstract Number: T 35
Abstract Type: Original Research
Background: Continuous spinal anesthesia (CSA) has been shown to be effective and safe in older patients (1), but experience is limited in the obstetric population. The prolonged presence of a spinal catheter (SC) after dural puncture (DP) has been reported to reduce the incidence of postdural puncture headache (PDPH) (2), and common practice at our institution is to place a SC following inadvertent DP. Although overall failure rate of CSA in non-obstetric patients is reported to be 2-4% (1), our anecdotal experience suggests a higher rate. We report a retrospective series of parturients managed with CSA.
Methods: Patients who had SCs placed were identified by searching our database. Individual records were reviewed for information related to patient demographics, planned neuraxial technique, adequacy of analgesia/anesthesia, and adverse events. Primary outcome was inadequacy of SCs, as defined by a need to replace the SC with a second neuraxial technique or use of other supplemental analgesic modalities (i.e., intravenous narcotic, general anesthetic for c-section).
Results: Of patients identified with SC placement from 2002 to 2012, 32 have been reviewed in this ongoing analysis. Age was 31.9 ± 6.6 years (mean ± SD). SCs were placed in 17 patients following DP during epidural placement, and 13 during combined-spinal epidural (8 placed for labor analgesia, 4 placed at the time of c-section, 1 at the time of tubal ligation). In two patients, CSA was planned for c-section. Duration of catheter left in situ was 18.9 ± 9.9 hours (mean ± SD). 13 were managed by patient controlled spinal analgesia (PCSA), 11 of which required adjusted settings. Two catheters were initially managed as epidural catheters due to delayed recognition of intrathecal catheter placement. Remaining patients were managed with clinician-administered boluses of intrathecal medication. 17 had a vaginal delivery, and 15 were delivered by cesarean section. CSA was inadequate in 6 patients (18.8%)—3 required a second neuraxial technique, 2 required IV narcotics during cesarean delivery, and 1 required conversion to general anesthetic for cesarean delivery. Adverse events were noted in 5 patients, related to a high block or hypotension. PDPH occurred in 20 patients (62.5%), and epidural blood patch was performed in 11 (34.4%).
Conclusion: Preliminary results suggest that CSA is safe in parturients. Failure rate was higher in our series than reported in the literature for non-obstetric patients (1). Incidence of PDPH in our series suggests that placement of SC following inadvertent DP might not significantly decrease the incidence of PDPH. Future work may compare the efficacy and safety of SCs vs. re-siting the epidural following inadvertent DP.
1. Denny NM, Selander DE. Continous spinal anesthesia. Br J Anaesth 1998; 81: 590-597.
2. Denny N, Masters R, Pearson D, et al. Postdural puncture headache after continuous spinal anaesthesia. Anesth Analg 1987; 66:791-794.