Minimising the risk of accidental dural puncture with epidural analgesia for labour: a retrospective review of risk factors
International Journal of Obstetric Anesthesia , 07/05/2012
Hollister N et al. – The authors conclude that the risk of accidental dural puncture increases with increasing depth to the epidural space.Methods
- The authors performed a retrospective review of 18385 epidurals, performed over a 15–year period.
- Factors analysed were: time of day of insertion, loss–of–resistance technique, maternal position, cervical dilatation, grade of anaesthetist and depth to the epidural space.
- Using univariate analyses the authors found no association between the risk of accidental dural puncture and the following variables: time of day of insertion (P=0.71), loss–of–resistance technique (P=0.22), maternal position for insertion (P=0.83), degree of cervical dilatation (P=0.41) and grade of anaesthetist performing the epidural (P=0.34).
- Conversely, they found that the risk of accidental dural puncture increased with increasing depth to the epidural space.
- This was confirmed using a logistic regression analysis, from which it was estimated that, for every 1–cm increase in depth, the risk of accidental dural puncture increased by approximately 19% (P=0.019; 95% CI for OR: 1.029–1.38).