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Published on: January 31, 2025
Low Unintended Dural Puncture Rate Using a Flush-Measure-Check-Advance Technique to Perform Combined Spinal-Epidural
James Riopelle1, Julie Gayle1, Zubaer Anwar2
1Department of Anesthesiology, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA.
Background:
Reported rates of unintended dural puncture during performance of continuous epidural anesthesia (CEA) or combined spinal-epidural anesthesia (CSEA) have remained steady at approximately 0.5% to 1% since the 1970s.
Methods:
A modified method of inserting the Tuohy epidural catheterization needle was used during performance of CSEA in 393 parturients. A single staff/faculty anesthesiologist performed or supervised resident use of a flush-measure-check-advance Tuohy needle insertion algorithm.
Results:
The rate of evident Tuohy needle dural puncture during the series was 0%. One parturient experienced a post-dural puncture headache possibly because of intentional subarachnoid puncture with a very small diameter (25 gauge) needle during 2 CSEAs. In 19 parturients, the initial spinal anesthesia portion of CSEA failed, prompting conversion to CEA in 18 parturients and to spinal anesthesia in 1 parturient.
Conclusion:
The use of a flush-measure-check-advance Tuohy needle insertion algorithm to reduce the likelihood of unintended dural puncture during performance of CSEA in parturients deserves further study.
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