Authors: Chopra I et al.
Journal: Cureus, Volume 17, Issue 12, Article e100456
Summary
This systematic review evaluates whether placement of an intrathecal catheter (ITC) following accidental dural puncture (ADP) reduces the incidence of post-dural puncture headache (PDPH). PDPH remains a frequent and morbid complication of neuraxial anesthesia, particularly in young and obstetric patients, with reported incidence rates exceeding 50% after ADP. The authors aimed to synthesize current evidence regarding ITC placement as a preventive strategy and assess its safety profile.
Eleven studies met inclusion criteria, comprising two randomized controlled trials, six cohort studies, one case series, and two case reports. Study populations were predominantly obstetric patients, though some non-obstetric adult cases were included. Comparisons centered on ITC placement versus repeat epidural or standard management after ADP. Due to substantial heterogeneity in study design, catheter gauge, duration of placement, patient population, and definitions of PDPH, quantitative meta-analysis was not performed; a narrative synthesis was used instead.
Across cohort studies, most demonstrated a lower incidence of PDPH and reduced need for epidural blood patch when ITCs were placed and maintained for approximately 24 hours. Large relative reductions were reported in several observational studies, especially when compared with immediate catheter removal or repeat epidural placement. In contrast, randomized data were mixed, with one controlled study showing no significant reduction in PDPH rates, though repeat epidural placement was associated with higher procedural complications and risk of repeat dural puncture.
Safety outcomes were generally favorable. Serious neurologic complications and infections were not reported in association with ITC use. Transient paresthesia, hypotension, pruritus, and technical difficulties with catheter placement or removal were the most commonly described adverse events. Case reports and case series further supported feasibility and short-term safety, though they did not provide efficacy-level evidence.
Overall, the review concludes that ITC placement after ADP appears promising for reducing PDPH incidence and epidural blood patch requirements, but methodological limitations and heterogeneity prevent definitive conclusions. The authors emphasize the need for large, well-designed randomized trials with standardized definitions and protocols to determine the true preventive benefit of ITCs.
What You Should Know
• Accidental dural puncture carries a high risk of PDPH, particularly in obstetric patients.
• Observational studies consistently suggest lower PDPH and epidural blood patch rates with intrathecal catheter placement.
• Randomized trial data are limited and show mixed results.
• Safety data are reassuring, with no strong signal for neurologic injury or infection.
• Heterogeneity in catheter size, duration, and outcome definitions limits firm recommendations.
Key Points
• Study type: systematic review with narrative synthesis (11 studies).
• Population: adults with accidental dural puncture, predominantly obstetric patients.
• Intervention: intrathecal catheter placement after ADP.
• Main finding: trend toward reduced PDPH and blood patch use, driven mainly by cohort data.
• Evidence gap: lack of large, standardized randomized trials.
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