Home > Riviste > Minerva Anestesiologica > Fascicoli precedenti > Minerva Anestesiologica 2013 Ottobre;79(10) > Minerva Anestesiologica 2013 Ottobre;79(10):1187-97

ULTIMO FASCICOLO
 

ARTICLE TOOLS

Estratti

MINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,036


eTOC

 

REVIEWS  


Minerva Anestesiologica 2013 Ottobre;79(10):1187-97

lingua: Inglese

Can the incidence of accidental dural puncture in laboring women be reduced? A systematic review and meta-analysis

Heesen M. 1, Klöhr S. 1, Rossaint R. 2, Van De Velde M. 3, Straube S. 4

1 Department of Anesthesiology, Klinikum am Bruderwald, Bamberg, Germany;
2 Department of Anesthesiology, University Hospital Aachen, Aachen, Germany;
3 Department of Anesthesiology, University Hospital Gasthuisberg, Leuven, Belgium;
4 Institute of Occupational, Social and Environmental Medicine, University Medical Center Göttingen, Göttingen


FULL TEXT  


Background: Accidental dural puncture (ADP) after epidural analgesia (EDA) for labor pain may cause severe postdural puncture headache (PDPH) and may prolong hospital stay. We aimed to identify techniques that reduce the incidence of ADP.
Methods: A systematic literature search was performed. Data on the occurrence of ADP and PDPH were extracted and subjected to meta-analysis. The random effects model was applied. Risk ratios (RR) and 95% confidence intervals (CI) were calculated.
Results: We identified 54 articles, 13 non-randomized controlled trials and 41 randomized controlled trials (RCTs), reporting on a total of 98,869 patients. In non-RCTs, the use of liquid for the identification of the epidural space was associated with a reduced risk of ADP compared to the use of air (RR 0.55, 95% CI 0.39 to 0.79, P=0.001). In our analysis of RCTs this comparison did not produce a significant difference. No effect was found for combined spinal-epidural analgesia, maternal position, type of the catheter, needle size, bevel direction, operator experience, or use of ultrasound.
Conclusion: A reduction of the risk of ADP was found for liquid use for the loss of resistance, but only in lower quality studies. Based on current evidence, we cannot make a recommendation regarding any of the techniques under study. Therefore, clinicians should focus on measures to prevent or treat PDPH once ADP has occurred.

inizio pagina

Publication History

Per citare questo articolo

Corresponding author e-mail