A prospective controlled study of continuous spinal analgesia versus repeat epidural analgesia after accidental dural puncture in labour

Russell, I.F.

doi:10.1016/j.ijoa.2011.10.005

Cited by 83 publications

(61 citation statements)

References 22 publications

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“…After delivery in this patient, the spinal catheter was left in place for 24 hours. However, Russell et al, in a prospective controlled study in 2012, demonstrated no benefi t to leaving an intrathecal catheter in place ( 8 ). Today, we routinely remove spinal catheters shortly after vaginal or cesarean delivery.…”

Section: Discussionmentioning

confidence: 99%

Epidural Analgesia Complicated by Dural Ectasia in the Marfan Syndrome

Vacula

Gray

Hofkamp

et al. 2016

Baylor University Medical Center Proceedings

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Section: Discussionmentioning

confidence: 99%

Epidural Analgesia Complicated by Dural Ectasia in the Marfan Syndrome

Vacula

Gray

Hofkamp

et al. 2016

Baylor University Medical Center Proceedings

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“…Second, these patients are at increased risk of developing a PDPH. Although keeping intrathecal catheters in situ for 24 hr was thought to reduce the incidence of PDPH 16 , a recent prospectively controlled trial 14 showed no difference in either the incidence of headache or use of blood patch if intrathecal catheters were maintained for 24 hr.…”

Section: Discussionmentioning

confidence: 99%

Failed epidural analgesia in a parturient with advanced ankylosing spondylitis: a novel explanation

Hoffman

Zaphiratos

Girard

et al. 2012

Can J Anesth/J Can Anesth

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Purpose Ankylosing spondylitis (AS) is a chronic progressive multisystemic disease. Patients with AS present a specific set of anesthesia-related challenges, and the parturient with AS presents particular anesthetic considerations. We report our experience with a parturient with advanced AS and offer a novel explanation for the high incidence of epidural failures in this patient population. Clinical features We present the case of a 36-yr-old primigravida parturient with a very difficult airway and a history of severe AS. The initial treatment plan was to use a continuous epidural for labour analgesia. Despite two successful placements of lumbar epidural catheters, adequate rostral spread of local anesthesia to control her labour pain was never achieved via the epidural route. Thus, continuous spinal anesthesia was used, which provided effective labour analgesia in this patient. Conclusion We hypothesize that this patient's advanced calcified posterior longitudinal ligament caused a physical barrier to rostral spread of local anesthesia solution within her epidural space. This hypothesis is supported by a recent study highlighting the importance of this ligament in allowing adequate distribution of solution within the epidural space. In addition, the successful use of continuous spinal analgesia adds to the growing body of literature supporting the safety and efficacy of intrathecal catheters for labour analgesia in specific situations. RésuméObjectif La spondylarthrite ankylosante (SpA) est une maladie chronique e´volutive affectant plusieurs syste`mes. Les patients souffrant de SpA posent une se´rie de de´fis spe´cifiques lie´s à l'anesthe´sie et les proble`mes d'une parturiente souffrant de SpA ne´cessitent une approche encore plus e´labore´e. Nous de´crivons notre expe´rience avec une parturiente atteinte de SpA avance´e et proposons une nouvelle explication pour l'incidence e´leve´e d'e´checs de la pe´ridurale dans cette population de patientes. Caractéristiques cliniques Nous pre´sentons le cas d'une parturiente de 36 ans, primipare, ayant des ante´ce´dents de SpA se´ve`re et des voies ae´riennes difficiles. Le plan the´rapeutique initial consistait a`utiliser une pe´ridurale continue pour l'analge´sie au cours du travail. Malgre´la mise en place re´ussie de deux cathe´ters pe´riduraux par voie lombaire, une diffusion rostrale approprie´e de l'anesthe´sie locale pour atte´nuer sa douleur n'a jamais e´teó btenue par voie pe´ridurale. En conse´quence, une

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“…18-gauge) reduces the risk or severity of PDPH. 1,4,14,15 Bed rest and hydration are not effective, 16 nor is there sufficient evidence to support any drug therapy, with the possible exception of repeated doses of epidural morphine 17 or a single dose of intravenous cosyntropin (a synthetic adrenocorticotrophic hormone analogue). 18 The latter approaches may not suit the clinical circumstances and it would be unwise to change practice based on the positive findings of a single small www.obstetanesthesia.com randomised trial for each drug.…”

mentioning

confidence: 99%

“…11,19 Bearing-down at delivery may have an impact, but the only randomised trial did not find benefit in avoiding bearing-down in the second stage of labour 20 and this is unappealing because of its major obstetric implications. Rather than repeating an epidural, intrathecal placement of the epidural catheter allows effective analgesia to be established with fewer complications 15 and has become increasingly popular, 21 but strict safety measures need to be implemented; whether this prevents PDPH is contentious. While this approach is strongly supported by some anaesthetists, my personal experience does not correspond at all with the large beneficial effect observed in a non-randomised study; 22 observational studies have been equivocal.…”

mentioning

confidence: 99%

“…In this issue of the journal, Russell reports the results of a prospective controlled study that provides the best evidence to date -namely no reduction in the incidence of headache or blood patch. 15 When PDPH ensues, evidence supporting treatment with some therapies is rather more encouraging, but high-level evidence is again scarce. Difficulty in performing a risk-benefit analysis for the various management strategies can give the anaesthetist a sore head.…”

mentioning

confidence: 99%

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