Moreno Giménez Gerard, Melo Cruz Martha Cristina, Ferrándiz Mach Marta, Sabaté Tenas Sergi
Department of Anesthesiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
Department of Anesthesiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
Rev Esp Anestesiol Reanim (Engl Ed). 2025 Apr;72(4):501671. doi: 10.1016/j.redare.2024.501671. Epub 2024 Dec 19.
Post-dural puncture headache (PDPH) after an accidental dural puncture (ADP) is a common complication in obstetric analgesia. It has been proposed that inserting an intrathecal catheter (ITC) after an ADP may reduce PDPH incidence and the need for therapeutic epidural blood patch (EBP). Our primary objective was to assess if the insertion of an ITC after an ADP reduces the incidence of PDPH in obstetric patients. Secondary objectives included evaluating EBP requirements and ITC-related complications.
We conducted a retrospective study of all obstetric patients with a documented ADP during their labour analgesia between January 2018 to December 2022. Data from the patients in whom an ITC was inserted and those with a repeated epidural were compared.
Over our 5-year study period, 35 cases of ADP were documented. Of these, 16 patients (45.7%) received an ITC for 24 hours, while 19 (54.3%) underwent epidural re-siting. No significant difference was observed in PDPH incidence between ITC and re-sited epidural groups (62.5% vs 68.4%; RR 0.84; P = 0.713), nor in EBP requirement (18.8% vs 31.6%; RR 0.84; P = 0.387). Follow-up duration did not differ significantly between groups and no ITC-related complications were reported within 1 month.
Our findings align with previously reported literature, indicating a trend favoring ITC utilization. In addition to the potential benefit of reducing CPPD incidence, their use is safe and provides quality analgesia with rapid onset.
IIBSP-CEF-2022-146.
意外硬膜穿刺（ADP）后发生的硬膜穿刺后头痛（PDPH）是产科镇痛中常见的并发症。有人提出，ADP后插入鞘内导管（ITC）可能会降低PDPH的发生率以及治疗性硬膜外血贴（EBP）的需求。我们的主要目的是评估ADP后插入ITC是否能降低产科患者PDPH的发生率。次要目的包括评估EBP的需求以及与ITC相关的并发症。
我们对2018年1月至2022年12月期间所有在分娩镇痛时有ADP记录的产科患者进行了一项回顾性研究。比较了插入ITC的患者和重复硬膜外穿刺患者的数据。
在我们5年的研究期间，记录了35例ADP。其中，16例患者（45.7%）接受ITC 24小时，而19例（54.3%）接受了硬膜外重新穿刺。ITC组和重新穿刺硬膜外组之间的PDPH发生率（62.5%对68.4%；RR 0.84；P = 0.713）以及EBP需求（18.8%对31.6%；RR 0.84；P = 0.387）均无显著差异。两组之间的随访时间无显著差异，且1个月内未报告与ITC相关的并发症。
我们的研究结果与先前报道的文献一致，表明倾向于使用ITC的趋势。除了有可能降低CPPD发生率外，其使用是安全的，且能提供起效迅速的优质镇痛。
IIBSP-CEF-2022-146。
