Title of article :
Dural Puncture During Spinal Cord Stimulator Lead Insertion: Analysis of Practice Patterns
Author/Authors :
Southerland ، Warren A. Department of Anesthesia - Beth Israel Deaconess Medical Center, Critical Care, and Pain Medicine - Harvard Medical School , Hasoon ، Jamal Department of Anesthesia - Beth Israel Deaconess Medical Center and Pain Medicine - Harvard Medical School , Urits ، Ivan Department of Anesthesia - Beth Israel Deaconess Medical Center and Pain Medicine - Harvard Medical School , Viswanath ، Omar Department of Anesthesia and Pain Management - Health Sciences Center - Louisiana State University , Simopoulos ، Thomas T. Department of Anesthesia - Beth Israel Deaconess Medical Center and Pain Medicine - Harvard Medical School , Imani ، Farnad Department of Anesthesiology and Pain Medicine - Pain Research Center - Iran University of Medical Sciences , Karimi-Aliabadi ، Hakimeh Department of Anesthesiology - Kerman University of Medical Sciences , Aner ، Musa M Dartmouth-Hitchcock Medical Center, Center for Pain and Spine - Geisel School of Medicine , Kohan ، Lynn Pain Management Center, School of Medicine - University of Virginia , Gill ، Jatinder Department of Anesthesia - Beth Israel Deaconess Medical Center and Pain Medicine - Harvard Medical School
From page :
1
To page :
8
Abstract :
Background: Spinal cord stimulation (SCS) is an important modality for intractable pain not amenable to less conservative measures. During percutaneous SCS lead insertion, a critical step is safe access to the epidural space, which can be complicated by a dural puncture. Objectives: In this review, we present and analyze the practices patterns in the event of a dural puncture during a SCS trial or implantation. Methods: We conducted a survey of the practice patterns regarding spinal cord stimulation therapy. The survey was administered to members of the Spine Intervention Society and American Society of Regional Anesthesia specifically inquiring decision making in case of inadvertent dural puncture during spinal cord stimulator lead insertion. Results: A maximum of 193 responded to a question regarding dural punctures while performing a SCS trial and 180 responded to a question regarding dural punctures while performing a SCS implantation. If performing a SCS trial and a dural puncture occurs, a majority of physicians chose to continue the procedure at a different level (56.99%), followed by abandoning the procedure (27.98%), continuing at the same level (10.36%), or choosing another option (4.66%). Similarly, if performing a permanent implantation and a dural puncture occurs, most physicians chose to continue the procedure at a different level (61.67%), followed by abandoning the procedure (21.67%), continuing at the same level (10.56%), or choosing another option (6.11%). Conclusions: Whereas the goals of the procedure would support abandoning the trial but continuing with the permanent in case of inadvertent dural puncture, we found that decision choices were minimally influenced by whether the dural puncture occurred during the trial or the permanent implant. The majority chose to continue with the procedure at a different level while close to a quarter chose to abandon the procedure. This article sets a time stamp in practice patterns from March 20, 2020 to June 26, 2020. These results are based on contemporary SCS practices as demonstrated by this cohort, rendering the options of abandoning or continuing after dural puncture as reasonable methods. Though more data is needed to provide a consensus, providers can now see how others manage dural punctures during SCS procedures.
Keywords :
Postdural Puncture Headache , Patient Safety , Chronic Pain , Dural Puncture , Neuromodulation , Spinal Cord Stimulation
Journal title :
Anesthesiology and Pain Medicine
Journal title :
Anesthesiology and Pain Medicine
Record number :
2725223
Link To Document :
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