Dural Puncture

This is an informal guideline offering suggested local practice for accidental dural punctures.

This has been a longstanding area of contention, with registrars consequently being left with no clear idea of what they should /could / are allowed to do after an accidental tap.  There has been a significant trend, both in  Australia and internationally, to start utilising intrathecal catheters in this situation, and the topic has been discussed repeatedly over the last couple of years at the obstetric anaesthesia meetings.

The document supports either resiting the epidural or feeding an intrathecal catheter, and offers some guidance around this choice and subsequent management options. There is also a section on PDPH management. Many of the finer points, eg around dosing an IT catheter, are not derived from a solid evidence base, and are certainly not the only way to go about things. There is value in consistency, however, and the suggested approach seems a reasonable way to begin with.

All anaesthetists may find themselves involved in these tricky management situations.   Over time, with feedback, appropriate amendments to these suggested practices will be made.


Background/Reference Material

Discussion Notes


To make comments or suggest any changes to this guideline please send your email to perioptalkdesk@gmail.com