DECREASED INCIDENCE OF HEADACHE AFTER ACCIDENTAL DURAL PUNCTURE IN CESAREAN DELIVERY PATIENTS RECEIVING CONTINUOUS POSTOPERATIVE INTRATHECAL ANALGESIA

examine the effects of prolonged (> 24 h) intrathecal catheterization with the use of postoperative analgesia on the incidence of post-dural puncture headache (PDPH), charts of 45 obstetric patients who had accidental dural puncture following attempts at epidural block were reviewed retrospectively Three groups were identified: Group I (n= 15) patients had a dural puncture on the first attempt at epidural block, but successful epidural block on a repeated attempt; Group II (n=17) patients had a dural puncture with immediate conversion to continuous spinal anaesthesia with catheterization lasting only For the duration of caesarean delivery; Group III (n=13) patients had an immediate conversion to spinal anaesthesia and received postcaesarean section continuous intrathecal patient-controlled analgesia consisting of fentanyl 5 mu g . ml(-1) with bupivacaine 0.25 mg . ml(-1) and epinephrine 2 mu g . ml(-1) with catheterization lasting > 24 h. No parturient in group III developed a PDPH. This was substantially lower (P<0.009) than the 33% incidence for group I and the 47% incidence for group II. The incidence of a PDPH did not differ between group I and II. Similarly, there was no difference between group I and II with regard to requests for a blood patch. Patients receiving continuous intrathecal analgesia had excellent pain relief, could easily ambulate and none complained of pruritus, nausea, vomiting, sensory loss or weakness. In conclusion, indwelling spinal catheterization >24 h with continuous intrathecal analgesia following accidental dural puncture in parturients may for some patients be a suitable method for providing PDPH prophylaxis and postoperative analgesia.