Document Type
Article
Publication Date
9-23-2025
Publication Title
Ochsner Journal
Abstract
Background: Reported rates of unintended dural puncture during performance of continuous epidural anesthesia (CEA) or combined spinal-epidural anesthesia (CSEA) have remained steady at approximately 0.5% to 1% since the 1970s. Methods: A modified method of inserting the Tuohy epidural catheterization needle was used during performance of CSEA in 393 parturients. A single staff/faculty anesthesiologist performed or supervised resident use of a flush-measure-check-advance Tuohy needle insertion algorithm. Results: The rate of evident Tuohy needle dural puncture during the series was 0%. One parturient experienced a post-dural puncture headache possibly because of intentional subarachnoid puncture with a very small diameter (25 gauge) needle during 2 CSEAs. In 19 parturients, the initial spinal anesthesia portion of CSEA failed, prompting conversion to CEA in 18 parturients and to spinal anesthesia in 1 parturient. Conclusion: The use of a flush-measure-check-advance Tuohy needle insertion algorithm to reduce the likelihood of unintended dural puncture during performance of CSEA in parturients deserves further study.
First Page
187
Last Page
195
PubMed ID
40995159
Volume
25
Issue
3
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Riopelle, James; Gayle, Julie; Anwar, Zubaer; and Burton, Jeff, "Low Unintended Dural Puncture Rate Using a Flush-Measure-Check-Advance Technique to Perform Combined Spinal-Epidural Anesthesia in Parturients: A Quality Improvement Clinical Series" (2025). School of Medicine Faculty Publications. 4206.
https://digitalscholar.lsuhsc.edu/som_facpubs/4206
10.31486/toj.24.0133
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