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Preliminary findings and outcomes associated with the use of a continuous spinal protocol for labor pain relief following accidental dural puncture
  1. Marcos Izquierdo1,
  2. Xiao-Feng Wang2,
  3. Karl Wagner III1,
  4. Cristian Prada1,
  5. Augusto Torres1 and
  6. Norman Bolden1
  1. 1 Department of Anesthesiology, MetroHealth Medical Center, Cleveland, Ohio, USA
  2. 2 Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Norman Bolden, Anesthesiology, MetroHealth Medical Center, Cleveland, OH 44109, USA; nbolden{at}metrohealth.org

Abstract

Background Various interventions have shown promise in reducing complications following accidental dural puncture. However, these have yet to be studied as a single, comprehensive protocol. The aim of this study is to compare outcomes associated with the use of a continuous spinal protocol for labor pain relief versus resiting the epidural catheter following accidental dural puncture.

Methods We reviewed the charts of patients managed via our continuous spinal protocol and compared this group with patients for whom the epidural was resited following accidental dural puncture during the 5-year period prior to implementing our protocol. We assessed incidence of postdural puncture headache, epidural blood patch, frequency of catheter replacement, use of pressors, verbal pain scores at 0, 1, 2, 3, 4 hours following catheter placement, infection rates (meningitis/epidural abscess) and mode of delivery.

Results There were 129 women in the continuous spinal protocol group and 52 in the resited epidural group. The incidence of postdural puncture headache was lower in the continuous spinal group versus the resited epidural group (21.7% vs 67.3%, p<0.001), and the incidence of epidural blood patch was lower in the continuous spinal group versus the resited epidural group (12.4% vs 50.0%, p<0.001). Verbal pain scores were consistently lower in the continuous spinal group compared with the resited epidural group at all time intervals studied.

Conclusion Patients managed via this continuous spinal protocol had significantly lower incidence of postdural puncture headache and epidural blood patch with more effective labor analgesia following accidental dural puncture.

  • Spinal/Epidural Injection
  • Neuraxial blocks: Epidural
  • Postdural Puncture Headache
  • Neuraxial blocks: Continuous techniques
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Footnotes

  • Contributors MI, KW, CP and AT participated in study design, data collection, data analysis and preparation of the manuscript. MI also designated as the archival author who is responsible for maintaining the study records. X-FW helped design the study, helped with data analysis and performed statistical analysis, and helped prepare the manuscript. NB helped design the study, conduct the study, collect data, data analysis and helped prepare the manuscript. MI, X-FW, KW, AT and CP approved the final manuscript. NB reviewed the original data, the data analysis and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Approval was obtained from the Institutional Review Board of MetroHealth Medical Center at Case Western Reserve University for this retrospective cohort study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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