Epidural injection at or around the level of accidental dural puncture : does it make a difference ?

Abstract EN

Background When accidental dural puncture (ADP) occurs, options are either to cancel the technique and administer general anesthesia, perform spinal anesthesia, or reattempt epidural at a level above or below the site of dural puncture.

The previous concept of avoiding the epidural technique at the same level as that of the ADP needs to be revised.

Patients and methods The patients in this study were those scheduled for elective orthopedic procedures under epidural anesthesia, during which ADP occurred.

Patients were divided randomly into three groups according to the level of epidural injection in relation to the site of ADP: group S included patients who received epidural anesthesia at the same site as that of the ADP.

Groups A and B included patients administered epidural anesthesia at a level above or below the site of ADP, respectively.

After identifying the epidural space, the test dose was administered.

If spinal anesthesia was administered, the operation was started and epidural anesthesia was canceled.

If no signs of intravenous injection or spinal anesthesia occurred, 20 ml bupivacaine 0.5% was injected into the epidural space.

The primary outcome was the safety of epidural anesthesia at the same level as that of ADP.

The secondary outcomes were simplicity and incidence of side effects.

Results No cases of untoward subarachnoid injection were recorded.

Identification of the epidural space was significantly easier and less time consuming in group S.

No significant difference was observed between the groups studied in terms of side effects (nausea, vomiting, and headache).

However, backache was significantly less in incidence and severity in group S.

Conclusion Epidural anesthesia at the site of ADP was as safe as at a level above or below.

Moreover, it was easier and less time consuming, with less incidence of backache.