NORTH-AMERICAN SURVEY OF THE MANAGEMENT OF DURAL PUNCTURE OCCURRING DURING LABOR EPIDURAL ANALGESIA

Purpose: To document the range and the most common strategies for the management of the parturient with inadvertent dural puncture (DP) duri ng labour epidural analgesia. Methods: A confidential survey form was mailed to 46 academic units in Canada and USA. The responses were comp iled into Canadian, US and joint North American databases. Results: Th irty-six centres (78%) responded, representing 137,250 annual deliveri es. The reported incidence of DP was 0.04-6%. The most common initial response to DP was re-siting the catheter at another level. Most centr es made little change in routine practice regarding epidural top-ups a nd infusion rates after DP. Unrestricted mobilisation was advocated by 86% of centres following delivery; enhanced oral hydration was encour aged by 61%. Prophylactic epidural blood patch (PEEP) was recommended by 37% of centres, with twice as many US as Canadian centres doing so. In the presence of PDPH, EBP was offered most commonly at or within 2 4 hr of diagnosis. Complications were common after EBP: 86% of centres reported patch failures; 44% reported persistent headache after great er than or equal to 2 EBP. Despite this, centres remained optimistic a bout EBP success, quoting cure rates >90% in 58% of centres. Conclusio n: There is little difference between the practices reported by Canadi an or US centres. The expressed optimism regarding the efficacy of EBP is not supported by the evidence available and may be unwarranted. Mo re research is needed to define the issue better.