Effective prevention of post-dural puncture headache with insertion of an intrathecal catheter in parturients: a retrospective study and meta-analysis
Abstract Background Accidental dural puncture is a common complication of labour analgesia. It can trigger post-dural puncture headache, with associated morbidity and increased costs. Intrathecal catheter placement is a prophylactic procedure which can reduce incidence and severity of post-dural pun...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | Journal of Anesthesia, Analgesia and Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s44158-023-00107-5 |
| _version_ | 1827894792986558464 |
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| author | F. Creazzola M. Aversano F. Prencipe R. Barelli P. Pasqualetti I. Simonelli M. G. Frigo |
| author_facet | F. Creazzola M. Aversano F. Prencipe R. Barelli P. Pasqualetti I. Simonelli M. G. Frigo |
| author_sort | F. Creazzola |
| collection | DOAJ |
| description | Abstract Background Accidental dural puncture is a common complication of labour analgesia. It can trigger post-dural puncture headache, with associated morbidity and increased costs. Intrathecal catheter placement is a prophylactic procedure which can reduce incidence and severity of post-dural puncture headache. Methods We conducted a retrospective single-centred study to define incidence and risk factors of accidental dural puncture and post-dural puncture headache in an obstetric population. We also evaluated effectiveness of intrathecal catheter placement compared to epidural catheter replacement in reducing incidence of post-dural puncture headache. We then conducted a systematic review and meta-analysis which included all studies comparing intrathecal catheter placement to epidural catheter replacement in obstetric patients with accidental dural puncture assessing the outcome of reduced incidence of post-dural puncture headache as a dichotomous variable. Results Accidental dural puncture had an incidence of 0.25% (60 cases). Of these, 66% developed post-dural puncture headache. A total of 77% (47/60) of patients with accidental dural puncture were treated with an intrathecal catheter placement, while 23% (13/60) had an epidural catheter replacement. Incidence of post-dural puncture headache was lower in the intrathecal catheter group (spinal 26/47, 60.5% epidural 11/13, 84.6%), although not reaching statistical significance (RR 0.71, CI 95%: 0.51–1.00; p = 0.049). The meta-analysis revealed that intrathecal catheter placement significantly reduced incidence of post-dural puncture headache compared to epidural catheter replacement (pooled RR 0.81, 95% CI 0.72–0.91, p < 0.001). Conclusions Intrathecal catheter placement is a promising measure to prevent post-dural puncture headache, especially if followed by a pain management protocol and a continuous saline infusion. |
| first_indexed | 2024-03-12T22:12:34Z |
| format | Article |
| id | doaj.art-0caa7102acb245bc95437725fd7cec65 |
| institution | Directory Open Access Journal |
| issn | 2731-3786 |
| language | English |
| last_indexed | 2024-03-12T22:12:34Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Anesthesia, Analgesia and Critical Care |
| spelling | doaj.art-0caa7102acb245bc95437725fd7cec652023-07-23T11:29:32ZengBMCJournal of Anesthesia, Analgesia and Critical Care2731-37862023-07-013111110.1186/s44158-023-00107-5Effective prevention of post-dural puncture headache with insertion of an intrathecal catheter in parturients: a retrospective study and meta-analysisF. Creazzola0M. Aversano1F. Prencipe2R. Barelli3P. Pasqualetti4I. Simonelli5M. G. Frigo6Obstetric Anaesthesia, San Camillo Forlanini HospitalObstetric Anaesthesia and Intensive Care Departmental Unit, Fatebenefratelli Gemelli Isola - Isola Tiberina HospitalObstetric Anaesthesia and Intensive Care Departmental Unit, Fatebenefratelli Gemelli Isola - Isola Tiberina HospitalAnaesthesia and Intensive Care Unit, Sant’Eugenio HospitalService of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and EducationService of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and EducationObstetric Anaesthesia and Intensive Care Departmental Unit, Fatebenefratelli Gemelli Isola - Isola Tiberina HospitalAbstract Background Accidental dural puncture is a common complication of labour analgesia. It can trigger post-dural puncture headache, with associated morbidity and increased costs. Intrathecal catheter placement is a prophylactic procedure which can reduce incidence and severity of post-dural puncture headache. Methods We conducted a retrospective single-centred study to define incidence and risk factors of accidental dural puncture and post-dural puncture headache in an obstetric population. We also evaluated effectiveness of intrathecal catheter placement compared to epidural catheter replacement in reducing incidence of post-dural puncture headache. We then conducted a systematic review and meta-analysis which included all studies comparing intrathecal catheter placement to epidural catheter replacement in obstetric patients with accidental dural puncture assessing the outcome of reduced incidence of post-dural puncture headache as a dichotomous variable. Results Accidental dural puncture had an incidence of 0.25% (60 cases). Of these, 66% developed post-dural puncture headache. A total of 77% (47/60) of patients with accidental dural puncture were treated with an intrathecal catheter placement, while 23% (13/60) had an epidural catheter replacement. Incidence of post-dural puncture headache was lower in the intrathecal catheter group (spinal 26/47, 60.5% epidural 11/13, 84.6%), although not reaching statistical significance (RR 0.71, CI 95%: 0.51–1.00; p = 0.049). The meta-analysis revealed that intrathecal catheter placement significantly reduced incidence of post-dural puncture headache compared to epidural catheter replacement (pooled RR 0.81, 95% CI 0.72–0.91, p < 0.001). Conclusions Intrathecal catheter placement is a promising measure to prevent post-dural puncture headache, especially if followed by a pain management protocol and a continuous saline infusion.https://doi.org/10.1186/s44158-023-00107-5Labour epidural analgesiaPost-dural puncture headacheAccidental dural punctureIntrathecal catheter |
| spellingShingle | F. Creazzola M. Aversano F. Prencipe R. Barelli P. Pasqualetti I. Simonelli M. G. Frigo Effective prevention of post-dural puncture headache with insertion of an intrathecal catheter in parturients: a retrospective study and meta-analysis Journal of Anesthesia, Analgesia and Critical Care Labour epidural analgesiaPost-dural puncture headache Accidental dural puncture Intrathecal catheter |
| title | Effective prevention of post-dural puncture headache with insertion of an intrathecal catheter in parturients: a retrospective study and meta-analysis |
| title_full | Effective prevention of post-dural puncture headache with insertion of an intrathecal catheter in parturients: a retrospective study and meta-analysis |
| title_fullStr | Effective prevention of post-dural puncture headache with insertion of an intrathecal catheter in parturients: a retrospective study and meta-analysis |
| title_full_unstemmed | Effective prevention of post-dural puncture headache with insertion of an intrathecal catheter in parturients: a retrospective study and meta-analysis |
| title_short | Effective prevention of post-dural puncture headache with insertion of an intrathecal catheter in parturients: a retrospective study and meta-analysis |
| title_sort | effective prevention of post dural puncture headache with insertion of an intrathecal catheter in parturients a retrospective study and meta analysis |
| topic | Labour epidural analgesiaPost-dural puncture headache Accidental dural puncture Intrathecal catheter |
| url | https://doi.org/10.1186/s44158-023-00107-5 |
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