Complications of unintentional dural puncture during labour epidural analgesia: a 10-year retrospective observational study
Abstract Introduction Unintentional dural puncture (UDP) occurs in 0.5–1.5% of labour epidural analgesia cases. To date, little is known about evidence of UDP-related complications. This work aimed to assess the incidence of intrapartum and postpartum complications in parturients who experienced UDP...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | Journal of Anesthesia, Analgesia and Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s44158-023-00127-1 |
| _version_ | 1827632727019487232 |
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| author | S. Poma M. C. Bonomo G. Gazzaniga M. Pizzulli A. De Silvestri C. Baldi F. Broglia M. Ciceri M. Fuardo F. Morgante S. Pellicori E. M. Roldi M. P. Delmonte F. Mojoli A. Locatelli |
| author_facet | S. Poma M. C. Bonomo G. Gazzaniga M. Pizzulli A. De Silvestri C. Baldi F. Broglia M. Ciceri M. Fuardo F. Morgante S. Pellicori E. M. Roldi M. P. Delmonte F. Mojoli A. Locatelli |
| author_sort | S. Poma |
| collection | DOAJ |
| description | Abstract Introduction Unintentional dural puncture (UDP) occurs in 0.5–1.5% of labour epidural analgesia cases. To date, little is known about evidence of UDP-related complications. This work aimed to assess the incidence of intrapartum and postpartum complications in parturients who experienced UDP. Methods This is a 10-year retrospective observational study on parturients admitted to our centre who presented UDP. Data collection gathered UDP-related complications during labour and postpartum. All women who displayed UDP received medical therapy and bed rest. An epidural blood patch (EBP) was not used in this population. Once asymptomatic, patients were discharged from the hospital. Results Out of 7718 neuraxial analgesia cases, 97 cases of UDP occurred (1.25%). During labour, complications appeared in a small percentage of analgesia procedures performed, including total spinal anaesthesia (1.0%), extended motor block (3%), hypotension (4.1%), abnormal foetal heart rate (2%), inadequate analgesia (14.4%), and general anaesthesia following neuraxial anaesthesia failure (33.3% of emergency caesarean sections). During the postpartum period, 53.6% of parturients exhibited a postdural puncture headache, 13.4% showed neurological symptoms, and 14.4% required neurological consultation and neuroimaging. No patient developed subdural hematoma or cerebral venous sinus thrombosis; one woman presented posterior reversible encephalopathy syndrome associated with eclampsia. Overall, 82.5% of women experienced an extension of hospital stay. Conclusion Major complications occurred in a small percentage of patients during labour. However, since they represent high-risk maternal and neonatal health events, a dedicated anaesthesiologist and a trained obstetric team are essential. No major neurological complications were registered postpartum, and EBP was not performed. Nevertheless, all patients with UDP were carefully monitored and treated until complete recovery before discharge, leading to an extension of their hospitalization. |
| first_indexed | 2024-03-09T14:49:38Z |
| format | Article |
| id | doaj.art-b7a5e35e7e2241c8837a00303e284d82 |
| institution | Directory Open Access Journal |
| issn | 2731-3786 |
| language | English |
| last_indexed | 2024-03-09T14:49:38Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Anesthesia, Analgesia and Critical Care |
| spelling | doaj.art-b7a5e35e7e2241c8837a00303e284d822023-11-26T14:32:59ZengBMCJournal of Anesthesia, Analgesia and Critical Care2731-37862023-10-01311710.1186/s44158-023-00127-1Complications of unintentional dural puncture during labour epidural analgesia: a 10-year retrospective observational studyS. Poma0M. C. Bonomo1G. Gazzaniga2M. Pizzulli3A. De Silvestri4C. Baldi5F. Broglia6M. Ciceri7M. Fuardo8F. Morgante9S. Pellicori10E. M. Roldi11M. P. Delmonte12F. Mojoli13A. Locatelli14Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital FoundationDepartment of Anaesthesia and Intensive Care, ASST Bergamo EST, Seriate HospitalDepartment of Anaesthesia and Intensive Care 1, I.R.C.C.S. Policlinic San Matteo Hospital FoundationAnaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital FoundationClinical Epidemiology and Biostatistics, Scientific Direction, I.R.C.C.S. Policlinic San Matteo Hospital FoundationAnaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital FoundationAnaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital FoundationAnaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital FoundationAnaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital FoundationAnaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital FoundationAnaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital FoundationAnaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital FoundationAnaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital FoundationDepartment of Anaesthesia and Intensive Care 1, I.R.C.C.S. Policlinic San Matteo Hospital FoundationAnaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital FoundationAbstract Introduction Unintentional dural puncture (UDP) occurs in 0.5–1.5% of labour epidural analgesia cases. To date, little is known about evidence of UDP-related complications. This work aimed to assess the incidence of intrapartum and postpartum complications in parturients who experienced UDP. Methods This is a 10-year retrospective observational study on parturients admitted to our centre who presented UDP. Data collection gathered UDP-related complications during labour and postpartum. All women who displayed UDP received medical therapy and bed rest. An epidural blood patch (EBP) was not used in this population. Once asymptomatic, patients were discharged from the hospital. Results Out of 7718 neuraxial analgesia cases, 97 cases of UDP occurred (1.25%). During labour, complications appeared in a small percentage of analgesia procedures performed, including total spinal anaesthesia (1.0%), extended motor block (3%), hypotension (4.1%), abnormal foetal heart rate (2%), inadequate analgesia (14.4%), and general anaesthesia following neuraxial anaesthesia failure (33.3% of emergency caesarean sections). During the postpartum period, 53.6% of parturients exhibited a postdural puncture headache, 13.4% showed neurological symptoms, and 14.4% required neurological consultation and neuroimaging. No patient developed subdural hematoma or cerebral venous sinus thrombosis; one woman presented posterior reversible encephalopathy syndrome associated with eclampsia. Overall, 82.5% of women experienced an extension of hospital stay. Conclusion Major complications occurred in a small percentage of patients during labour. However, since they represent high-risk maternal and neonatal health events, a dedicated anaesthesiologist and a trained obstetric team are essential. No major neurological complications were registered postpartum, and EBP was not performed. Nevertheless, all patients with UDP were carefully monitored and treated until complete recovery before discharge, leading to an extension of their hospitalization.https://doi.org/10.1186/s44158-023-00127-1Labour analgesiaPostdural puncture headacheUnintentional dural punctureNeuraxial analgesiaLabour complications |
| spellingShingle | S. Poma M. C. Bonomo G. Gazzaniga M. Pizzulli A. De Silvestri C. Baldi F. Broglia M. Ciceri M. Fuardo F. Morgante S. Pellicori E. M. Roldi M. P. Delmonte F. Mojoli A. Locatelli Complications of unintentional dural puncture during labour epidural analgesia: a 10-year retrospective observational study Journal of Anesthesia, Analgesia and Critical Care Labour analgesia Postdural puncture headache Unintentional dural puncture Neuraxial analgesia Labour complications |
| title | Complications of unintentional dural puncture during labour epidural analgesia: a 10-year retrospective observational study |
| title_full | Complications of unintentional dural puncture during labour epidural analgesia: a 10-year retrospective observational study |
| title_fullStr | Complications of unintentional dural puncture during labour epidural analgesia: a 10-year retrospective observational study |
| title_full_unstemmed | Complications of unintentional dural puncture during labour epidural analgesia: a 10-year retrospective observational study |
| title_short | Complications of unintentional dural puncture during labour epidural analgesia: a 10-year retrospective observational study |
| title_sort | complications of unintentional dural puncture during labour epidural analgesia a 10 year retrospective observational study |
| topic | Labour analgesia Postdural puncture headache Unintentional dural puncture Neuraxial analgesia Labour complications |
| url | https://doi.org/10.1186/s44158-023-00127-1 |
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