An audit of accidental dural puncture during epidural insertion of a Tuohyneedle in obstetric patients

We report a prospective audit of 100 parturients who experienced accidental dural puncture by a Tuohy needle, while attending a tertiary referral obst etric unit juring the period 1993 1999. The post dural puncture headache ra te was 81% and the diagnosis of dural puncture was delayed until presentati on of the headache in 27% of these cases. The incidence of unrecognised dur al puncture was not influenced by the technique used for identification of the epidural space. Intraspinal opioid administration after Jural puncture was associated with a significant reduction in the incidence of headache (P < 0.04), There was no association between mode of delivery and post dural puncture headache. Deliberate cannulation of the subarachnoid space with an epidural catheter at the time of dural puncture, for continuous spinal ana lgesia or anaesthesia, did not affect the incidence of post dural puncture headache but was associated with a significantly reduced rate of epidural b lood patch (43% versus 80%, P < 0.01). Of those who developed post dural pu ncture headache, 48% were classified 'severe' and in 49% the headache prese nted within 24 h of dural puncture. There was a trend to earlier onset of h eadache (either immediate or within 24 h) when the epidural identification technique was loss-of-resistance to air rather than saline (54% versus 33%, P = 0.07). Twenty-eight percent of those suffering from post dural punctur e headache were treated expectantly and 72% received a therapeutic blood pa tch. Of seven parturients who received sumatriptan, six found it ineffectiv e and five subsequently received a blood patch. (C) 2001 Harcourt Publisher s Ltd.