We read the interesting case report from Sinha et al [1], referring to subdural hygroma in an unrecognised dural puncture. However, we were concerned by the comments expressed in regard to patient follow-up. The authors state that epidural insertion “was abandoned after a few unsuccessful attempts” and go onto say that “Because the epidural procedure was abandoned, our patient was neither followed up nor received an information leaflet”.

Surely this was the type of patient who needed follow up?  Several attempts at epidural insertion had been made, and the anatomy was not correctly identified. The needle may have caused unknown damage to other tissues, which in this case, apparently occurred. Follow up of these patients is the only way in which complications may be recognised and leaves the patient’s care open to criticism. Whilst follow up the next day may not have altered the recognition of the patient's evolving problems, it may have allowed the patient to contact the department more easily and at an earlier stage.

At The Royal Women’s Hospital, any patient who has an intervention by an anaesthetist, successful or not, is followed up by a visit from the pain team, and given an information leaflet with the contact details of the department, in case of any problems.

We would recommend that the same practice is adopted by all obstetric centres as standard medical care. Guidelines from the OAA/AAGBI also support this [2]. 

References:

1.             Shinha A, Petkov S,  Meldrum D. Unrecognised dural puncture resulting in subdural hygroma and cortical vein thrombosis. Anaesthesia 2010; 65: 70-73.

 2.  OAA / AAGBI Guidelines for Obstetric Anaesthetic Services. Revised Edition. OAA &

       AAGBI 2005.