[Treatment of accidental dural puncture during obstetric epidural analgesia]. / Tratamiento de la punción dural accidental en la analgesia epidural del trabajo de parto.

OBJECTIVE: To assess the effectiveness of continuous intrathecal analgesia as prophylaxis for postdural puncture headache (PDPH) and for analgesia during labor in 12 patients who suffered accidental dural puncture. PATIENTS AND METHODS: A total of 920 patients who received spinal analgesia during labor were enrolled. Group A (no accidental dural puncture) received a single dose of 10 mL of 0.2% ropivacaine, and 5 minutes later continuous epidural infusion of 0.125% ropivacaine and 3 micromg mL(-1) was started at a rate of a 5 mL h(-1); a 5 mL bolus dose was allowed every 20 minutes if needed. In patients who suffered accidental dural puncture (Group B) we inserted an intrathecal catheter to administer an initial dose of 3 mL of 0.2% ropivacaine and the same analgesic mixture at the same dose as was administered in Group A. Patient characteristics, analgesic efficacy, duration of labor and delivery, motor blockade, analgesic volume, and incidence of PDPH were recorded. The Student t test was used for statistical comparisons. RESULTS: No significant differences in duration of labor and delivery, analgesic efficacy, or motor blockade were observed. The incidence of PDPH was 16.6% in Group B and 0.33% in Group A. The patients in Group B required more additional bolus doses: 10 (SD, 2) in Group B and 3 (1.25) in Group A (P<0.01). CONCLUSIONS: Continuous intrathecal analgesia after accidental dural puncture was a safe way to provide analgesia during labor and to reduce the expected incidence of PDPH.