Letters

Inadvertent dural puncture

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7245.1338 (Published 13 May 2000) Cite this as: BMJ 2000;320:1338

Avoiding unintentional puncture is a primary goal of obstetric anaesthetists

  1. Allan Cyna, staff anaesthetist (cynaa@mail.wch.sa.gov.au)
  1. Department of Obstetric and Gynaecological Anaesthesia, Women and Children's Hospital, Adelaide SA 5006, Australia
  2. Queen Alexandra Hospital, Portsmouth PO6 3LY

    EDITOR—While reading Weir's account of her experience of dural puncture I was trying to determine what could have been done to improve the situation.1 Severe postdural puncture headache is fortunately uncommon and represents one end of the range of an event that occurs in <2% of parturients having a regional technique. Avoiding this complication completely would mean denying women the most effective, reliable means of providing analgesia for labour and delivery.2

    The administration of three failed epidurals and two spinal blocks suggests that this patient's lumbar spine presented technical difficulty to the anaesthetist(s) concerned. Early onset of postdural puncture headache is unusual as most such headaches do not begin for 24 hours; headache during caesarean section is commonly related to fatigue, stress, or dehydration.

    Once postdural puncture headache is diagnosed, early administration of a blood patch may be less effective than waiting 24 hours.3 Giving opioids to supplement analgesia, followed by conversion to general anaesthesia, was …

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