Decreased incidence of headache after unintentional dural puncture in patients with cesarean delivery administered with postoperative epidural analgesia

• Published in: Journal of anesthesia Vol. 23; no. 1; pp. 31 - 35
• Main Authors: Cesur, Mehmet, Alici, Haci A., Erdem, Ali F., Silbir, Fikret, Celik, Mine
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 2009
• Subjects: Adult; Analgesia, Epidural; Analgesia, Obstetrical; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Anesthesiology; Anesthetics, Local - administration & dosage; Anesthetics, Local - therapeutic use; Cesarean Section; Critical Care Medicine; Emergency Medicine; Female; Humans; Intensive; Medicine; Medicine & Public Health; Morphine - administration & dosage; Morphine - therapeutic use; Original Article; Pain Measurement; Pain Medicine; Post-Dural Puncture Headache - prevention & control; Postoperative Nausea and Vomiting - epidemiology; Pregnancy; Young Adult; Cesarean delivery; Post-dural puncture headache; Morphine; Epidural blood patch
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-008-0690-7

Purpose
To investigate how subsequent placement of a catheter into the epidural space after unintentional dural puncture for postoperative analgesia for 36–72 h affected the incidence of post-dural puncture headache (PDPH).
Methods
The records of 52 parturients who had had accidental dural puncture in cesarean delivery were reviewed. The parturients were assigned to two groups. Twenty-eight parturients were assigned to the study group, in whom an epidural catheter was inserted and was used for anesthesia and postoperative analgesia. Twenty-four parturients were assigned to the control group, in whom spinal anesthesia (
n
= 20) or general anesthesia (
n
= 4) was applied. For postoperative analgesia in patients with incision pain above visual analog scale (VAS) 3, 3 mg morphine in 15 ml saline was administered through the epidural catheter in the study group, while intramuscular meperidine or tramadol was administered in the control group. Once PDPH was observed, conservative treatment was tried first. If the headache persisted despite conservative treatment, an epidural blood patch was applied through the catheter or a reinserted epidural needle.
Results
The study group demonstrated significant reduction of the incidence of PDPH and reduction in the indication for an epidural blood patch compared to the control group (7.1% vs 58% [
P
= 0.000] and 3.6% vs 37.5% [
P
= 0.002], respectively).
Conclusion
Subsequent catheter placement into the epidural space after unintentional dural puncture in cesarean delivery and leaving the catheter for postoperative analgesia for 36–72 h may reduce the incidence of PDPH.