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Lumbar Spine Anatomy in Women Sustaining Unintentional Dural Puncture During Labor Epidural Placement

A Descriptive Study Using Magnetic Resonance Imaging and Ultrasound

Barrett, N.M.; Arzola, C.; Krings, T.; Downey, K.; Carvalho, J.C.A.

Obstetric Anesthesia Digest: December 2018 - Volume 38 - Issue 4 - p 223
doi: 10.1097/01.aoa.0000547325.09720.25
Anesthesia and Analgesia: Regional Analgesia

(Reg Anesth Pain Med. 2018;43:92–96)

Unintentional puncture of the dura mater is one of the most common complications of epidural catheter placement and can result in a postdural puncture headache. The incidence of this complication has remained unchanged and efforts to identify patient risk factors have been unsuccessful. There has not been success in identifying risk factors for this complication. A retrospective study showed there was a higher risk of atypical sonoanatomy of the ligamentum flavum/dura mater unit among women who experienced unintentional dural puncture during epidural placement compared with a control group. It was not clear whether this was a limitation of ultrasound imaging or a representation of abnormal anatomy. The objectives of this study were to assess for abnormal lumbar anatomy in women sustaining unintentional dural punctures during labor epidural placement utilizing magnetic resonance imaging (MRI) and ultrasound.

Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada

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