Canadian Journal of Anaesthesia

, Volume 45, Issue 1, pp 42–45

Intrathecal catheter insertion during labour reduces the risk of postdural puncture headache

Clinical Reports

Abstract

Purpose

To describe the anaesthetic management and report the incidence of PDPH in three parturients who had experienced accidental durai puncture during labour and the subsequent deliberate intrathecal insertion of an epidural catheter.

Clinical features

Inadvertent durai puncture with a 16-gauge Tuohy needle occurred during the first stage of labour at 3–4 cm cervical dilatation in all three women. The 20-gauge epidural catheter was immediately inserted into the subarachnoid space after accidental durai penetration. Intermittent intrathecal injections of lidocaine or bupivacaine with fentanyl were administered to provide analgesia during labour and delivery. Two of the women had spontaneous vaginal deliveries, whereas Caesarean section was performed in one case due to acute fetal distress during the second stage of labour. The intrathecal catheter was left in-situ for 13–19 hr after delivery and the women were questioned daily for symptoms of PDPH. None of the three women developed PDPH after dural puncture and intrathecal catheterisation with the epidural catheter.

Conclusion

Immediate intrathecal insertion of the epidural catheter after accidental durai puncture during labour proved to be an effective prophylactic technique to prevent PDPH in these three parturients.

Résumé

Objectif

Évoquer la conduite anesthésique et l’incidence de la céphalée postponction dure-mérienne (CPPDM) chez trois parturientes dont la dure-mère a été ponctionnée pendant le travail et chez qui on a inséré un cathéter sous-arachnoïdien.

Éléments cliniques

La dure-mère a été ponctionnée accidentellement avec une aiguille Tuohy 16G pendant le premier stage du travail alors que la dilatation était à 3–4 cm chez les trois femmes. Un cathéter épidural 20G a été introduit dans l’espace sous-arachnoïdien immédiatement après la ponction. Des injections sous-arachnoïdiennes de lidocaïne ou de bupivacaïne avec du fentanyl ont été effectuées pour procurer l’anesthésie pendant le travail et l’accouchement. Deux des femmes ont accouché spontanément par voie vaginale, alors que la troisième a dû subir une césarienne à cause d’une détresse foetale survenue pendant le deuxième stage du travail. On a laissé le cathéter sous-arachnoïdien en place pendant 13 à 19 h après l’accouchement et recherché à chaque jour les symptômes de CPPDM. Aucune des trois femmes n’a développé de CPPDM après la ponction de la duremère et l’insertion du cathéter épidural.

Conclusion

L’insertion immédiate d’un cathéter épidural après une ponction accidentelle de la dure-mère pendant le travail s’est avérée une technique prophylactique efficace à prévenir la CPPDM chez ces trois parturientes.

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Copyright information

© Canadian Anesthesiologists 1998

Authors and Affiliations

  1. 1.Department of AnaesthesiaOttawa Civic Hospital, University of OttawaOttawaCanada

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