Perhaps leave spinal catheters on the shelf

I am not sure of the current availability in Australia of spinal catheter kits, but a paper in Feb 08 Anesthesiology by Arkoosh et al does not make me at all enthusiastic to use them for labour analgesia. In this FDA sanctioned RCT, a 28 G catheter through a 22 G Sprotte needle worked well for 90 + % majority, but 8% were dislodged (including one on transfer for emergency CS), one broke in situ (and was retained) and one broke on the outside. Later, 9 % had PDPH and 5.3 % required blood patch for the headache. It seemed to be a fiddly technique in the investigators' hands, although a 4% PDPH rate in the epidural control group makes me wonder about their proficiency. Nonetheless, I cannot see how spinal catheter analgesia could surpass epidural catheter analgesia as a first choice for labour analgesia. Even if spinal catheter analgesia or anaesthesia is warranted in an extreme situation (and Drasner and Smiley in the accompanying epidural writes:

of course, CSA is the clear answer for the anxious Oral Boards candidate when faced with the semimythical case of the morbidly obese, severely preeclamptic, asthmatic parturient with the class 4 airway presenting for urgent cesarean delivery)

then I think the stronger 20 G catheter we usually use for epidural analgesia may be a better option. If the clinical situation is dire, then the PDPH problem has to be deferred to a later time. Thankfully obesity and previous spinal surgery or disease are protective against PDPH.