Intrathecal Catheter Insertion After Unintentional Dural Puncture

Abstract

Epidural analgesia is a common method of pain relief during labour and delivery . Furthermore a combination of spinal and epidural technique is still a reasonable choice for use in patients treated with orthopedic surgeries as total hip and knee replacements. Prophylactic measures have been attempted after accidental dural puncture with an epidural needle because of the high risk of developing post-dural puncture headache (PDPH). Conservative managment usually includes hydration with iv or oral fluids and analgesic medication. Many reports have suggested that leaving the catheter in the dural hole for several hours may decrease the incidence of PDPH. In that case report ; after unintentional dural puncture, inserting the catheter through the dural tear, maintaining intrathecal analgesia and leaving the catheter in place for 20 hours presented. Key words: Post-Dural Puncture Headache, İntentional Dural Puncture, Epidural Needle, İntrathecal Catheter

Keywords

• Post-Dural Puncture Headache, İntentional Dural Puncture, Epidural Needle, İntrathecal Catheter

İstenmeyen Dura Ponksiyonu Sonrası İntratekal Kateter Yerleştirilmesi: Olgu Sunumu

Abstract

Epidural analjezi doğum ve doğum ağrısı sırasında ağrının önlenmesinde yaygın bir yöntemdir. Ayrıca kombine spinal epidural teknik hala total kalça ve diz protezi gibi ortopedik cerrahi hastalarının tedavisinde kullanmak için mantıklı bir tercihtir. Epidural iğne ile kazara dural ponksiyon sonrası postdural ponksiyon başağrısı (PPB) insidansının yüksek olması nedeniyle profilaktik tedbirler alınmaktadır. Koruyucu yönetim genellikle iv veya oral sıvı replasmanı ve analjezik tedaviyi içerir. Birçok çalışma kateterin birkaç saatliğine dural delikte bırakılmasının PPB insidansını azaltabileceğini göstermiştir. Bu olguda; istenmeyen dural ponksiyon sonrası dural yırtıktan kateterin yerleştirilmesi, intratekal analjezinin sürdürülmesi ve 20 saat boyunca kateterin intratekal alanda bırakılması sunuldu. Anahtar kelimeler: Postdural Ponksiyon Başağrısı, İstenmeyen Dural Ponksiyon, Epidural İğne, İntratekal Kateter

Keywords

• Postdural Ponksiyon Başağrısı, İstenmeyen Dural Ponksiyon, Epidural İğne, İntratekal Kateter

References

1. Dennehy KC, Rosaeg OP. Intrathecal catheter insertion during labour reduces the risk of postdural puncture headache. Can J Anaesth 1998;1:42-5.
2. Türköz A, Kocum A. Intrathecal catheterization after unintentional dural puncture during orthopedic surgery. J Anesthesia 2010;24:43-48.
3. Morgan GE, Mikhail MS. Rejyonel Anestezi ve Ağrı Tedavisi. Klinik Anesteziyoloji Ankara Basımevi: Güneş Tıp Kitapevleri 2008;319-20.
4. Kuczkowski KM, Post-dural puncture headache in the obstetric patient: an old problem. New solutions. Minerva Anestesiol 2004;70:823-24.
5. Collier CB. Complications of Regional Anesthesia. In: Textbook of Birnbach DJ. Obstetric Anesthesia 2000;504-23.
6. Kuczkowski KM, Post dural puncture headache, intracranial air and obstetric anesthesia. Anaesthesist 2003;52:798-800.
7. Carbaat PAT, van Crevel H. Lumbar puncture headach: controlled study on the preventive effect of 24 hours’ bed rest. Lancet 1981;1:1133-5.
8. Ahmed SV. Jayawarm C. Post-lumbar puncture headache: diagnosis and management. Postgrad Med J 2006;82:713-6.

9. Stride PC, Cooper GM. Dural taps revisited. A 20-year survey from Birmingham Maternity Hospital. Anaesthesia 1993;48:247- 55.
10. Craft JB, Epstein BS. Prophylaxis of dural-puncture headache wite epidural saline. Anesth Analg 1973;52:228-31.
11. Bark AJ, Wheeler AS. Comparison of epidural salin placement and epidural blood placement in the treatment of post-lumbar- puncture headache. Anesthesiology 1978;48.221-3.
12. Turnbull DK, Shepherd DB. Postdural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth 2003;97:718-29.
13. Palahniuk RJ, Cumming M. Prophylactic blood patch does not prevent post lumbar puncture headache. Can Anaesth Soc J 1979;26:132-3.
14. Denny N, Masters R. Postdural puncture headache after continuous spinal anesthesia. Anesth Analg 1987;66:791-4.
15. Cohen S, Amar D. Decreased incidence of headache after accident dural puncture in Caesarean delivery patients receiving continuous postoperative intrathecal analgesia. Acta Anaesthesiol Scand 1994;38:716-8.
16. Norrıs MC, Leighton BL. Continuous spinal anesthesia after unintentional dural puncture in parturients. Reg Anesth 1990;15:285-7.
17. Baraz R, Collis RE. The management of accidental dural puncture during labur epidural analgesia: a survey of UK practice. Anaesthesia 2005;60:673-9.
18. Bernards CM, Kopacz DJ. Effect of needle puncture on morphine and lidocaine flux through the spinal meninges of the monkey in vitro. Implications for combined spinal-epidural anesthesia. Anesthesiology 1994;80:853-8.
19. Okell RW, Springge JS. Unintentional dural puncture. A survey of recognition and management. Anaesthesia 1987;42:1110-3.