Cosyntropin Prophylaxis With Intrathecal Saline: Impact on Postdural Puncture Headache and Epidural Blood Patch

( Anaesthesia. 2024;79(1):91–92. doi: 10.1111/anae.16139. PMID: 37816309) One of the risks of neuraxial procedures for labor analgesia is accidental dural puncture (ADP), which may lead to further complications including postdural headache (PDPH). The most common treatment for PDPH is an epidural blood patch (EBP); however, this treatment is not infallible. An alternative approach includes the injection of prophylactic intravenous cosyntropin following the dural puncture, which may prevent PDPH or reduce the associated symptoms. Following ADP, anesthetists chose to either select a new site for the epidural or to place an intrathecal (IT) catheter. In this retrospective study, cases where an IT catheter was placed and either administration of intrathecal saline (predelivery) and/or prophylactic intravenous (IV) cosyntropin (postdelivery) occurred were examined to determine the impact on PDPH and EBP.