Reactions 1207 - 21 Jun 2008

SBupivacaine

Accidental dural puncture presenting as respiratoryinsufficiency and headache: 5 case reports

Accidental dural puncture occurred in five women [ages notstated] during obstetric epidural anaesthesia with bupivacaine;two of the women developed post-dural puncture headacheand three developed respiratory insufficiency.

The five women, who were part of a study, received a testdose of bupivacaine to confirm the correct position of thecatheter; they received either 15mg or 10mg of bupivacaine.Two women developed blocks to the T6 level each time theyreceived a bupivacaine top-up [dosage details not stated] andsubsequently had pain relief for 3–4 hours. Both womendeveloped post-dural puncture headache [time to reactiononset not stated]. Patients in the study who developed post-dural puncture headache were prescribed bedrest, duringwhich time they received low-dose heparin and TED stockingsfor prophylaxis of deep vein thrombosis. [Patient outcomes forthe two women not stated].

A further two women developed blocks that compromisedrespiration within 5 minutes of receiving an unfractionatedtop-up dose; one woman received bupivacaine 30mg and theother received bupivacaine 40mg. The women were intubated,underwent caesarean section, and were admitted to intensivecare. They received mechanical ventilation for 3–4 hours untilrespiratory function returned.

Another woman received 0.5% bupivacaine 3mL followingrecognised dural puncture with a Tuohy needle. Shedeveloped respiratory failure and was intubated within10 minutes. She underwent caesarean section. She receivedmechanical ventilation for 3–4 hours until respiratory functionreturned.Sprigge JS, et al. Accidental dural puncture and post dural puncture headache inobstetric anaesthesia: presentation and management: a 23-year survey in a districtgeneral hospital. Anaesthesia 63: 36-43, No. 1, Jan 2008 - England 801096061

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Reactions 21 Jun 2008 No. 12070114-9954/10/1207-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved