We commend Griffiths et al. [1] for their work on managing intrathecal catheters after inadvertent dural puncture in obstetric patients. These evidence-based recommendations complement and enhance previous guidelines published in Anaesthesia [2]. The recommendation for early removal of intrathecal catheters is particularly noteworthy, as it corresponds with recent findings in the field. We previously recommended leaving the intrathecal catheter for 24 h, but subsequent research has indeed shown no benefit in prolonged catheterisation. In a recent study of 550 cases of accidental dural puncture, we found no advantage in leaving the intrathecal catheter in for 24 h postpartum (postdural puncture headache, adjusted odds ratio (aOR) (95%CI) 1.01 (1.00–1.02), p = 0.015; epidural blood patch, aOR (95%CI) 1.00 (0.99–1.01), p = 0.40) [3]. This aligns well with the Obstetric Anaesthetists' Association current recommendation and supports the trend towards earlier catheter removal. Injecting intrathecal saline through the catheter was associated with decreased odds of developing postdural puncture headache (aOR (95%CI) 0.85 (0.73–0.99), p = 0.04) and reduced need for epidural blood patch (aOR (95%CI) 0.75 (0.64–0.87), p < 0.001) [3]. Moreover, there is some evidence suggesting that a combined approach, such as prophylactic cosyntropin administration with intrathecal 0.9% saline injection, may offer additional benefits in managing postdural puncture headache [4]. This area warrants further investigation and consideration in future updates.

We agree with the authors on the importance of long-term follow-up. However, we suggest extending the follow-up period and explicitly including screening for chronic pain and postpartum depression. Recent studies have shown that women who experience accidental dural puncture are at increased risk of both these complications [5].

We hope that ongoing research in intrathecal 0.9% saline injection, prophylactic treatments and the importance of extended follow-up with screening for chronic pain and postpartum depression can further optimise care for these patients.

我们赞扬 Griffiths 等人 [1] 在产科患者意外硬脑膜穿刺后管理鞘内导管的工作。这些循证建议补充和加强了之前发表在 Anaesthesia [2] 上的指南。早期拔除鞘内导管的建议特别值得注意，因为它与该领域的最新发现相符。我们之前建议将鞘内导管放置 24 小时，但随后的研究确实表明延长导管插入时间没有益处。在最近一项对 550 例意外硬脑膜穿刺病例的研究中，我们发现产后 24 小时保留鞘内导管没有优势（硬膜穿刺后头痛，校正比值比 （aOR） （95%CI） 1.01 （1.00–1.02），p = 0.015;硬膜外血贴，aOR （95%CI） 1.00 （0.99–1.01），p = 0.40） [3]。这与产科麻醉师协会目前的建议非常一致，并支持早期拔除导管的趋势。通过导管注射鞘内盐水与发生硬膜穿刺后头痛的几率降低 （aOR （95%CI） 0.85 （0.73-0.99），p = 0.04） 和减少对硬膜外血贴的需求 （aOR （95%CI） 0.75 （0.64-0.87），p < 0.001） [3]。此外，一些证据表明，联合方法，例如预防性给予促肾上腺素联合鞘内注射 0.9% 生理盐水，可能对治疗硬膜穿刺后头痛有更多益处 [4]。此区域值得在将来的更新中进一步调查和考虑。

我们同意作者关于长期随访重要性的观点。然而，我们建议延长随访期，并明确纳入慢性疼痛和产后抑郁的筛查。最近的研究表明，经历意外硬脑膜穿刺的女性患这两种并发症的风险增加 [5]。

我们希望正在进行的鞘内 0.9% 生理盐水注射、预防性治疗以及延长随访筛查慢性疼痛和产后抑郁症的重要性的研究可以进一步优化对这些患者的护理。