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Accidental Dural Puncture

  • Recognition: most commonly - obvious flow of CSF into LOR syringe, or epidural catheter/aspiration through filter.

      Alternatively becomes apparent following test dose.

  • Management: either thread catheter (3-4cm max) intrathecally, manage as spinal catheter (Label clearly, anaesthetist only top-ups, do not connect to infusion, bolus intermittently PRN, remember to account for deadspace, inform patient/midwife

  • Alternatively resite epidural in another interspace - senior help may be required. Bolus doses required may be less due to potential intrathecal spread. Infusion may be run, caution may be required with PCEA depending on behavior of block.

  • LSCS/Instrumental: top up with caution! Treat as spinal catheter or cautious epidural as appropriate. Incremental top-ups.

  • Follow-up: Leaflet on PDPH and follow up visit.

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