Management of Accidental Dural Puncture using Continuous Spinal Catheter in High-risk Geriatric Patient: A Case Report

Accidental Dural Puncture (ADP) during epidural placement occurs in 0.5-2% of cases. This can lead to significant complications. Converting such incidents into a Continuous Spinal Catheter (CSC) technique offers a practical approach and is an effective alternative for high-risk surgical patients. This approach not only salvages the neuraxial access but also provides titratable neuraxial blockade and postoperative analgesia. We report the case of a 75-year-old hypertensive female with a history of Pulmonary Thromboembolism (PTE) after prior hip surgery, who has presented for implant removal and uncemented hemiarthroplasty. During epidural placement, an ADP occurred at the L2-L3 level, so the catheter was deliberately secured in the subarachnoid space and used as a CSC. A titrated spinal anaesthesia was administered and supplemented intraoperatively. General Anaesthesia (GA) was also used due to anticipated discomfort. The patient remained haemodynamically stable throughout the 3.5-hour surgery. The catheter was retained for one day postoperatively, with no neurological complications or Post-Dural Puncture Headache (PDPH). CSC is a safe and effective alternative following ADP, providing stable haemodynamics and a reliable anaesthesia, and good postoperative analgesia, especially in high-risk patients. Administration of incremental doses of Local Anaesthesia (LA) through this technique reduces the risk of profound hypotension and allows real-time adjustments based on the patient’s haemodynamic responses.