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Unrecognised dural punctures – revisited

2003; Elsevier BV; Volume: 13; Issue: 1 Linguagem: Inglês

10.1016/j.ijoa.2003.08.004

1532-3374

Shaul Cohen, Mary Casciano, Vrunda Bhausar,

Head and Neck Surgical Oncology

We read with interest the letter by Davies and colleagues [1] Davies R.G. Laxton C.J. Donald F.A. Unrecognised dural punctures. International Journal of Obstetric Anesthesia. 2003; 12: 142-143 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar and would like to suggest another possible cause for unrecognized dural punctures. In the past, we have encountered and reported several cases of unrecognized dural punctures [2] Cohen S. Zada Y. A chronic headache was treated successfully by an epidural blood patch. International Journal of Obstetric Anesthesia. 2001; 10: 253 Abstract Full Text PDF PubMed Scopus (2) Google Scholar and have reported a simple technique to reduce their incidence. 3 Cohen S. Mastrado P. Zada Y. A simple technique to reduce the incidence of accidental dural puncture. Anaesthesia. 2001; 57: 306 Crossref Google Scholar , 4 Cohen S. Chhokra R. Bokhari F. A simple technique to reduce the incidence of accidental dural puncture. Anaesthesia. 2002; 57: 306 Crossref PubMed Scopus (1) Google Scholar While advancing the epidural needle into the epidural space, we observed unrecognized occlusions and suspected that these occlusions occurred from blood clots or a flap of tissue (e.g., ligamentum flavum) entering the epidural needle during its advancement. When loss-of-resistance to air was not achieved, the needle was further advanced, pierced the dura and was then removed, without the emergence of any cerebrospinal fluid. The epidural block was usually achieved in another interspace, the earlier dural puncture remaining unrecognized.