Anesthesia management after inadvertent dural puncture during application of epidural blockage
Year 2010,
Volume: 37 Issue: 4, 394 - 396, 01.12.2010
Kemal Tolga Saraçoğlu
Mine Çelik
Ayten Saraçoğlu
Abstract
Accidentally dural puncture during the application of epi­dural blockage is a rare complication. There are some treatment methods in anesthesia management of this complication. Inserting the epidural needle to another in­tervertebral disc space, replacing subarachnoid catheter, injection of spinal anesthetic solution wherein epidural needle or implementing general anesthesia are some of the methods that physicians applicate. We report a cesarean delivery patient\'s case in which we have composed an accidental dural puncture. We drew back the epidural needle till the level that no free cere­brospinal fluid (CSF) flow is seen. We confirmed this by injection aspiration technique. In this case, we revised the maneuvers of the anesthetist after unintentional dural puncture with protective and therapeutic methods of the most frequent complication postdural puncture headache (PDPH).
References
- Jadon A, Chakraborty S, Sinha N, Agrawal R. Intrathecal Catheterization by Epidural Catheter: Management of Ac- cidental Dural Puncture and Prophylaxis of PDPH Indian J Anaesth 2009;53:30-4.
- Agarwal A, Kishore K. Complications and controversies of regional anaesthesia: a review. India J Anaesth 2009;53:543- 53.
- Bezov D, Lipton RB, Ashina S. Post-dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiol- ogy. Headache 2010;50:1144-52.
- Schmittner MD, Terboven T, Dluzak M, et al. High incidence of post-dural puncture headache in patients with spinal saddle block induced with Quincke needles for anorectal surgery: a randomised clinical trial. Int J Colorectal Dis. 2010;25:775-81.
- Benhamou D, Hamza J, Ducot B. Postpartum headache af- ter epidural analgesia without dural puncture. Int J Obstet Anesth 1995;4:17-20.
- Cesur M, Alıcı HA, Erdem AF. Decreased incidence of head- ache after unintentional dural puncture in patients with ce- sarean delivery administered with postoperative epidural analgesia. J Anesthesia 2009; 23:31-5.
- Russell I. In the event of accidental dural puncture by an epidural needle in labour, the catheter should be passed into the subarachnoid space. Int J Obstet Anesth 2002;11:23-7.
- Takmaz AS, Kantekin UC, Kaymak C, Basar H. Treatment of post-dural puncture headache with bilateral greater oc- cipital nerve block. Headache 2010;50:869-72.
- Boonmak P, Boonmak S. Epidural blood patching for pre- venting and treating post-dural puncture headache. Co- chrane Database Syst Rev 2010;20:1791-9.
- Kim SH, Lee KH, Yoon KB, Park WY, Yoon DM. Sono- graphic estimation of needle depth for cervical epidural blocks. Anesth Analg 2008;106:1542-47.
- Ting CK, Tsou MY, Chen PT, et al. A new technique to as- sist epidural needle placement: fiberoptic-guided insertion using two wavelengths. Anesthesiology 2010;112:1128-35.
Epidural blok sırasında gelişen dural yırtık sonrası anestezi yönetimi
Year 2010,
Volume: 37 Issue: 4, 394 - 396, 01.12.2010
Kemal Tolga Saraçoğlu
Mine Çelik
Ayten Saraçoğlu
Abstract
Epidural blok uygulaması esnasında yanlışlıkla dural yırtık oluşturup subaraknoid alana girilmesi ender rastlanan bir komplikasyondur. Bu komplikasyonun tedavi yönetimin­de pratikte uygulanan birtakım yöntemler yer almaktadır. Epidural iğnenin çekilip başka bir intervertebral disk ara­lığından girilmesi, subaraknoid alana kateter bırakılması, epidural kateterden spinal anestezik ilaç enjeksiyonu ile spinal anestezi sağlanması yada genel anesteziye geçil­mesi klinisyenler tarafından uygulanan metodlar arasın­dadır. Sezeryan için epidural blok uygularken dural yırtık komplikasyonu gelişen olgumuzu sunduk. Olgumuzda beyin omurilik sıvısı (BOS) serbest akışının gözlemlen­mesinden sonra girişim yapılan epidural iğnenin BOS ak­mayacak seviyeye kadar geri çekilmesini ve bu seviyenin serum fizyolojik (SF) enjeksiyon aspirasyon tekniği ile epi­dural alan olduğu teyid edildikten sonra epidural kateterin yerleştirilmesini belirttik. Bu vaka sunumunda dural yırtık komplikasyonunda anestezistin yapabileceği manevralar, başağrısı için koruyucu ve tedavi edici yöntemler gözden geçirilmiştir.
References
- Jadon A, Chakraborty S, Sinha N, Agrawal R. Intrathecal Catheterization by Epidural Catheter: Management of Ac- cidental Dural Puncture and Prophylaxis of PDPH Indian J Anaesth 2009;53:30-4.
- Agarwal A, Kishore K. Complications and controversies of regional anaesthesia: a review. India J Anaesth 2009;53:543- 53.
- Bezov D, Lipton RB, Ashina S. Post-dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiol- ogy. Headache 2010;50:1144-52.
- Schmittner MD, Terboven T, Dluzak M, et al. High incidence of post-dural puncture headache in patients with spinal saddle block induced with Quincke needles for anorectal surgery: a randomised clinical trial. Int J Colorectal Dis. 2010;25:775-81.
- Benhamou D, Hamza J, Ducot B. Postpartum headache af- ter epidural analgesia without dural puncture. Int J Obstet Anesth 1995;4:17-20.
- Cesur M, Alıcı HA, Erdem AF. Decreased incidence of head- ache after unintentional dural puncture in patients with ce- sarean delivery administered with postoperative epidural analgesia. J Anesthesia 2009; 23:31-5.
- Russell I. In the event of accidental dural puncture by an epidural needle in labour, the catheter should be passed into the subarachnoid space. Int J Obstet Anesth 2002;11:23-7.
- Takmaz AS, Kantekin UC, Kaymak C, Basar H. Treatment of post-dural puncture headache with bilateral greater oc- cipital nerve block. Headache 2010;50:869-72.
- Boonmak P, Boonmak S. Epidural blood patching for pre- venting and treating post-dural puncture headache. Co- chrane Database Syst Rev 2010;20:1791-9.
- Kim SH, Lee KH, Yoon KB, Park WY, Yoon DM. Sono- graphic estimation of needle depth for cervical epidural blocks. Anesth Analg 2008;106:1542-47.
- Ting CK, Tsou MY, Chen PT, et al. A new technique to as- sist epidural needle placement: fiberoptic-guided insertion using two wavelengths. Anesthesiology 2010;112:1128-35.