Decreased incidence of headache after accidental dural puncture in caesarean delivery patients receiving continuous postoperative intrathecal analgesia

To examine the effects of prolonged (> 24 h) intrathecal catheterization with the use of postoperative analgesia on the incidence of post–dural puncture headache (PDPH), charts of 45 obstetric patients who had accidental dural puncture following attempts at epidural block were reviewed retrospectively. Three groups were identified: Group I (n = 15) patients had a dural puncture on the first attempt at epidural block, but successful epidural block on a repeated attempt; Group II (n=17) patients had a dural puncture with immediate conversion to continuous spinal anaesthesia with catheterization lasting only for the duration of caesarean delivery; Group III (n= 13) patients had an immediate conversion to spinal anaesthesia and received post–caesarean section continuous intrathecal patient–controlled analgesia consisting of fentanyl 5 (ig'ml‐1 with bupivacaine 0.25 mg·ml‐1 and epinephrine 2 μg·ml‐1 with catheterization lasting >24 h. No parturient in group III developed a PDPH. This was substantially lower (P < 0.009) than the 33% incidence for group I and the 47% incidence for group II. The incidence of a PDPH did not differ between group I and II. Similarly, there was no difference between group I and II with regard to requests for a blood patch. Patients receiving continuous intrathecal analgesia had excellent pain relief, could easily ambulate and none complained of pruritus, nausea, vomiting, sensory loss or weakness. In conclusion, indwelling spinal catheterization > 24 h with continuous intrathecal analgesia following accidental dural puncture in parturients may for some patients be a suitable method for providing PDPH prophylaxis and postoperative analgesia.

[1]  M. Domsky,et al.  Patient-controlled spinal analgesia for postoperative pain control. , 1992, Anesthesia and analgesia.

[2]  G. Blaise,et al.  A SPINAL CATHETER DOES NOT REDUCE POST-SPINAL HEADACHE AFTER CEASAREAN SECTION , 1991 .

[3]  B. Bevacqua,et al.  A791 IS POST-OPERATIVE INTRA-THECAL CATHETER USE ASSOCIATED WITH CNS INFECTIONS? , 1990 .

[4]  S. Datta,et al.  INTRATHECAL FENTANYL MAY REDUCE THE INCIDENCE OF SPINAL HEADACHE , 1989 .

[5]  J. Stene,et al.  LACK OF INFECTIONS FROM LONG TERM POST-TRAUMA EPIDURAL ANALGESIA , 1989 .

[6]  Venes Jl.  Infections of CSF shunt and intracranial pressure monitoring devices. , 1989 .

[7]  D. Selander,et al.  Postdural puncture headache after continuous spinal anesthesia. , 1987, Anesthesia and analgesia.

[8]  T. Yaksh,et al.  Studies of the Pharmacology and Pathology of Intrathecally Administered 4‐Anilinopiperidine Analogues and Morphine in the Rat and Cat , 1986, Anesthesiology.

[9]  A. J. Bart,et al.  Comparison of epidural saline placement and epidural blood placement in the treatment of post-lumbar-puncture headache. , 1978, Anesthesiology.

[10]  J. Craft,et al.  Prophylaxis of Dural‐Puncture Headache With Epidural Saline , 1973, Anesthesia and analgesia.

[11]  J. S. Crawford.  The prevention of headache consequent upon dural puncture. , 1972, British journal of anaesthesia.

[12]  H. Wolff,et al.  EXPERIMENTAL STUDIES ON HEADACHE: ANALYSIS OF THE HEADACHE ASSOCIATED WITH CHANGES IN INTRACRANIAL PRESSURE , 1943 .

[13]  J. Venes.  Infections of CSF shunt and intracranial pressure monitoring devices. , 1989, Infectious disease clinics of North America.

[14]  P. Crowhurst.  Accidental dural puncture. , 1985, Anaesthesia and intensive care.

[15]  H. Wolff,et al.  EXPERIMENTAL STUDIES ON HEADACHE , 1942 .