35960 Accidental dural puncture in a morbidly obese pregnant woman: what now? – case report

• Published in: Regional anesthesia and pain medicine Vol. 48; no. Suppl 1; p. A244
• Main Authors: Maia, Susana, Xavier, Beatriz, Sá, Miguel, Antunes, Eva, Carneiro, Alexandra, Caramelo, Susana, Catarina Sampaio Martins
• Format: Journal Article
• Language: English
• Published: Secaucus BMJ Publishing Group LTD 01-09-2023
• Subjects: Apgar score; Catheters; Epidural; Pregnancy
• ISSN: 1098-7339; 1532-8651
• DOI: 10.1136/rapm-2023-ESRA.457

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)Spinal-epidural anesthesia is a well-established technique for performing cesarian-section. Accidental dural puncture during this procedure is a possible complication, especially in obese obstetric patients.MethodsA morbidly obese 30-year-old with a body mass index of 59 was proposed for elective cesarian-section and myomectomy. We performed a spinal- epidural technique, and there was an accidental dural puncture with a Tuohy needle 18G. Given her phenotype, we had previously discussed the possibility of introducing the catheter in the intrathecal space if this complication took place. We followed up with our plan B, which allowed the administration of continuous spinal anesthesia. At the end of surgery, we administered intrathecal morphine, and the catheter was removed.ResultsThe surgery lasted one and half hours, and the patient was always hemodynamically stable. The newborn had an Apgar score of 9/10/10. We explained the potential complications to the patient, and she was evaluated daily during her hospital stay, without developing headache or other symptoms. There was no record of her visiting urgent care in the following days.ConclusionsWe need to be alert for the higher possibility of accidental dural puncture in obese pregnant women, the complications that might arise, and, as such, always have a plan B. In this case, we were able to provide optimal surgical conditions and effective post operative analgesia.