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Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant
Background and Aims Childbirth is a unique and exciting time for pregnant woman. Epidural analgesia during labor is gold standard technique for pain relief. Accidental dural puncture (ADP) during labor epidural is not uncommon and is distress moment for both patient and anaesthesiologist. Resiting epidural catheter (REC) at same or another space, or placing catheter into intrathecal (IT) space are two available options.
Methods We searched the review of literature, meta-analysis and retrospective studies of last ten years, related to ADP, intrathecal catheter (ITC), postdural puncture headache (PDPH), epidural blood patch (EBP) in parturients requesting labor analgesia.
Results The incidence of ADP is 0.2-3.6% and PDPH develops in 66% of patients. ITC reduces the incidence of PDPH to<30% and decreases the need of EBP by>50%, if the catheter is in place for >24 hours. ITC gives advantage of avoiding repeat ADP or failure to place a neuraxial catheter at all. REC carries 10% risk of second ADP. ITC allows immediate pain relief in labor patient with severe pain, difficulty in position, and non-reassuring fetal tracing. Parturients having morbid obesity, history of spine surgery, scoliosis and multiple attempts at epidural placement are candidates of ITC. ITC placed for labor analgesia can be extended for caesarean delivery (CD) using incremental dosing. There are no serious complications reported.
Decision to place catheter intrathecally or resite epidurally after ADP
Diluted local anaesthetic +opioid doses for labor analgesia and surgical anaesthesia
Path of Touhy needle while targeting epidural space from midline
Conclusions The ITC potentially decreases incidence of PDPH and need for EBP. Further, ITC guarantees a rapid onset, high quality and predictable labour analgesia or even surgical anaesthesia, if CD is required. Catheter identification and communication with labor staff avoid errors.