Biomaterial Database

North American survey of the management of dural puncture occurring during labour epidural analgesia. 1998

C W Berger, and E T Crosby, and W Grodecki

Department of Anaesthesia, University of Ottawa, Ottawa General Hospital, Ontario.

OBJECTIVE To document the range and the most common strategies for the management of the parturient with inadvertent dural puncture (DP) during labour epidural analgesia. METHODS A confidential survey form was mailed to 46 academic units in Canada and USA. The responses were compiled into Canadian, US and joint North American databases. RESULTS Thirty-six centres (78%) responded, representing 137,250 annual deliveries. The reported incidence of DP was 0.04-6%. The most common initial response to DP was resiting the catheter at another level. Most centres made little change in routine practice regarding epidural top-ups and infusion rates after DP. Unrestricted mobilisation was advocated by 86% of centres following delivery; enhanced oral hydration was encouraged by 61%. Prophylactic epidural blood patch (PEBP) 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 24 hr of diagnosis. Complications were common after EBP: 86% of centres reported patch failures; 44% reported persistent headache after > or = 2 EBP. Despite this, centres remained optimistic about EBP success, quoting cure rates > 90% in 58% of centres. CONCLUSIONS There is little difference between the practices reported by Canadian or US centres. The expressed optimism regarding the efficacy of EBP is not supported by the evidence available and may be unwarranted. More research is needed to define the issue better.

UI	MeSH Term	Description	Entries
D007744	Obstetric Labor Complications	Medical problems associated with OBSTETRIC LABOR, such as BREECH PRESENTATION; PREMATURE OBSTETRIC LABOR; HEMORRHAGE; or others. These complications can affect the well-being of the mother, the FETUS, or both.	Complications, Labor,Labor Complications,Complication, Labor,Complication, Obstetric Labor,Complications, Obstetric Labor,Labor Complication,Labor Complication, Obstetric,Labor Complications, Obstetric,Obstetric Labor Complication
D011247	Pregnancy	The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH.	Gestation,Pregnancies
D002110	Caffeine	A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes SMOOTH MUSCLE, stimulates CARDIAC MUSCLE, stimulates DIURESIS, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide PHOSPHODIESTERASES, antagonism of ADENOSINE RECEPTORS, and modulation of intracellular calcium handling.	1,3,7-Trimethylxanthine,Caffedrine,Coffeinum N,Coffeinum Purrum,Dexitac,Durvitan,No Doz,Percoffedrinol N,Percutaféine,Quick-Pep,Vivarin,Quick Pep,QuickPep
D002170	Canada	The largest country in North America, comprising 10 provinces and three territories. Its capital is Ottawa.
D003625	Data Collection	Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data.	Data Collection Methods,Dual Data Collection,Collection Method, Data,Collection Methods, Data,Collection, Data,Collection, Dual Data,Data Collection Method,Method, Data Collection,Methods, Data Collection
D004388	Dura Mater	The outermost of the three MENINGES, a fibrous membrane of connective tissue that covers the brain and the spinal cord.	Falx Cerebelli,Falx Cerebri,Pachymeninx,Tentorium Cerebelli
D005260	Female		Females
D005440	Fluid Therapy	Therapy whose basic objective is to restore the volume and composition of the body fluids to normal with respect to WATER-ELECTROLYTE BALANCE. Fluids may be administered intravenously, orally, by intermittent gavage, or by HYPODERMOCLYSIS.	Oral Rehydration Therapy,Rehydration,Rehydration, Oral,Oral Rehydration,Rehydration Therapy, Oral,Therapy, Fluid,Therapy, Oral Rehydration,Fluid Therapies,Oral Rehydration Therapies,Oral Rehydrations,Rehydration Therapies, Oral,Rehydrations,Rehydrations, Oral,Therapies, Fluid,Therapies, Oral Rehydration
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328	Adult	A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available.	Adults