PT  - JOURNAL ARTICLE
AU  - Riopelle, James
AU  - Gayle, Julie
AU  - Anwar, Zubaer
AU  - Burton, Jeff
TI  - 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
AID  - 10.31486/toj.24.0133
DP  - 2025 Sep 21
TA  - Ochsner Journal
PG  - 187--195
VI  - 25
IP  - 3
4099  - http://www.ochsnerjournal.org/content/25/3/187.short
4100  - http://www.ochsnerjournal.org/content/25/3/187.full
SO  - Ochsner J2025 Sep 21; 25
AB  - 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.