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Intrathecal catheterisation after observed accidental dural puncture in labouring women: update of a meta-analysis and a trial-sequential analysis

Published:August 09, 2019DOI:https://doi.org/10.1016/j.ijoa.2019.08.001

      Highlights

      • After observed dural puncture, intrathecal catheter insertion has been advocated.
      • Conventional meta-analysis shows post-puncture headache and blood patches are reduced.
      • Trial-sequential analysis tests for the presence of firm evidence in meta-analyses.
      • Trial-sequential analysis reveals insufficient evidence for drawing firm conclusions.
      • We call for an evidence-based clinical practice guideline.

      Abstract

      Background

      Our meta-analysis from 2013 showed that inserting a catheter intrathecally after an observed accidental dural puncture can reduce the need for epidural blood patch in labouring women requesting epidural analgesia. We updated our conventional meta-analysis and added a trial-sequential analysis (TSA).

      Methods

      A systematic literature search was conducted to identify studies that compared inserting the catheter intrathecally with an epidural catheter re-site or with no intervention. The extracted data were pooled and the risk ratio (RR) and 95% confidence interval (95%CI) for the incidence of post-dural puncture headache (PDPH) was calculated, using the random effects model. A contour-enhanced funnel plot was constructed. A TSA was performed and the cumulative Z score, monitoring and futility boundaries were constructed.

      Results

      Our search identified 13 studies, reporting on 1653 patients, with a low risk of bias. The RR for the incidence of PDPH was 0.82 (95%CI 0.71 to 0.95) and the RR for the need for epidural blood patch was 0.62 (95%CI 0.49 to 0.79); heterogeneity of both analyses was high. The TSA showed that the monitoring or futility boundaries were not crossed, indicating insufficient data to exclude a type I error of statistical analysis. Contour-enhanced funnel plots were symmetric, suggesting no publication bias.

      Conclusions

      Conventional meta-analyses showed for the first time that intrathecal catheterisation can reduce the incidence of PDPH. However, TSA did not corroborate this finding. Despite increasing use in clinical practice there is no firm evidence on which to base a definite conclusion.

      Keywords

      Introduction

      Labour epidural analgesia can be complicated by accidental dural puncture
      • Gleeson C.M.
      • Reynolds F.
      Accidental dural puncture rates in UK obstetric practice.
      which often leads to post-dural puncture headache (PDPH).
      • Choi P.T.
      • Galinski S.E.
      • Takeuchi L.
      • Lucas S.
      • Tamayo C.
      • Jadad A.R.
      PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies.
      • Sprigge J.S.
      • Harper S.J.
      Accidental dural puncture and post dural puncture headache in obstetric anaesthesia: presentation and management: a 23-year survey in a district general hospital.
      In the case of an observed dural puncture the catheter can be inserted intrathecally,
      • Cohen S.
      • Daitch J.S.
      • Goldiner P.L.
      An alternative method for management of accidental dural puncture for labor and delivery.
      an approach that has become increasingly popular over the last two decades and that was favoured by more than two-thirds of lead obstetric anaesthetists in the UK, according to a survey in 2013.
      • Ramaswamy K.K.
      • Burumdayal A.
      • Bhardwaj M.
      • Russell R.
      A UK survey of the management of intrathecal catheters.
      The catheter can plug the dural hole, thereby limiting the efflux of cerebrospinal fluid,
      • Cohen S.
      • Amar D.
      • Pantuck E.J.
      • Singer N.
      • Divon M.
      Decreased incidence of headache after accidental dural puncture in caesarean delivery patients receiving continuous post-operative intrathecal analgesia.
      which otherwise results in traction on pain-sensitive structures. Alternatively, epidural puncture and catheter insertion may be repeated at the same or a different interspace which, however, carries the risk of a second dural puncture.
      In 2013 we published a meta-analysis and found a significant reduction in the need for epidural blood patch (EBP), but not in the incidence of headache, from intrathecal catheterisation (ITC) after accidental dural puncture.
      • Heesen M.
      • Klöhr S.
      • Rossaint R.
      • Walters M.
      • Straube S.
      • van de Velde M.
      Insertion of an intrathecal catheter following accidental dural puncture: a meta-analysis.
      This study updates the evidence by including relevant literature from the past five years. Moreover, we performed trial-sequential analyses (TSAs) that test for the presence or absence of sufficient evidence for the conclusions obtained with conventional meta-analytical methods. Recent investigations showed that conventional meta-analyses alone were often premature and bear the risk of false-positive results.
      • Imberger G.
      • Gluud C.
      • Boylan J.
      • Wetterslev J.
      Systematic reviews of anesthesiologic interventions reported as statistically significant: problems with power, precision, and type 1 error protection.

      Methods

      Our meta-analysis followed the STROBE statement.
      • von Elm E.
      • Altman D.G.
      • Egger M.
      • Pocock S.J.
      • Gøtzsche P.C.
      • Vandenbroucke J.P.
      • et al.
      The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies.
      The study was registered with PROSPERO (CRD42018118403). We performed a literature search on December 12th, 2018 in the databases PubMed, Google Scholar, Cochrane Library, Embase, Web of Science with the following search terms: (Spinal or intrathecal or subarachnoid) and (catheter or anaesthesia or analgesia) or continuous spinal and (Spinal or intrathecal or subarachnoid) and (catheter or anaesthesia or analgesia) and (Inadvertent or unintentional or accidental) dural puncture and postdural puncture headache or epidural blood patch. We also screened the bibliography of the retrieved articles for further relevant references. We aimed to be as inclusive as possible and therefore also included abstracts.
      Studies were included according to the PICO acronym: P(atients): parturients scheduled for labour analgesia or anaesthesia for caesarean section; I(ntervention): inserting an intrathecal catheter upon observed accidental dural puncture; C(ontrol): epidural catheter re-site at the same or another interspace; O(utcomes): occurrence of PDPH, need for EBP. Additional secondary outcomes were the incidence of caesarean section in the labour analgesia studies, and side-effects.
      The methodological quality of observational studies was assessed with the ROBINS-I tool
      • Sterne J.A.
      • Hernán M.A.
      • Reeves B.C.
      • et al.
      ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions.
      and the quality of prospective randomised trials with the Cochrane risk of bias tool.

      Higgins JPT, Green S, editors. Chapter 7.7.3.5. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available at: www.handbook.cochrane.org. Accessed July 2019.

      Two researchers (MH, MK) independently screened the articles retrieved from the literature search for eligibility, and two researchers (MH, NH) performed the quality assessment and extracted the data (MH, CvdM).
      Conventional meta-analysis: For the dichotomous outcomes (such as incidence of PDPH, need for EBP and incidence of caesarean section) risk ratios (RRs) and 95% confidence intervals (95%CI) were calculated. A condition for calculating pooled effect estimates was the presence of at least 100 patients per treatment arm and at least three studies. If there were more than two ITC groups, we combined the data of the groups by simple addition. We applied a random effects model. I2 statistics were computed to assess heterogeneity.
      Trial-sequential analysis: Trial-sequential analysis is a statistical approach that allows the power of meta-analytical calculations to be assessed and it therefore controls for type I and II errors of statistical analysis. Details have been described previously.
      • Heesen M.
      • Rijs K.
      • Hilber N.
      • et al.
      Ephedrine versus phenylephrine as a vasopressor for spinal anaesthesia-induced hypotension in parturients undergoing high-risk caesarean section: meta-analysis, meta-regression and trial sequential analysis.
      Briefly, a cumulative Z-curve (the Z-test value at each meta-analysis update), the conventional level of significance (e.g. Z-score=1.96 for a P-value threshold of 5%, independent of the quantity of evidence that has accumulated), the number of patients in the meta-analysis, the estimated required information size, and the trial sequential significance and futility boundaries are constructed. The TSA significance boundaries adjust the thresholds for significance and the risk of type 1 error is less than 5%. If the Z curve crosses the monitoring and futility boundaries, then there is sufficient evidence in the individual analyses.
      Contour-enhanced funnel plots were performed if there were more than 10 studies. Plot asymmetry is an indicator of the existence of publication bias. We used the statistics programs RevMan for conventional meta-analysis, TSA software (version 0.9.5.10 Beta. Copenhagen Trial Unit, Copenhagen, Denmark) for TSA and R Studio version 1.0.136 for contour-enhanced funnel plots.

      Results

      Fig. 1 shows the flow chart with respect to selection of references. Of the 192 hits in our literature search (after removal of duplicates), 19 studies
      • Cohen S.
      • Amar D.
      • Pantuck E.J.
      • Singer N.
      • Divon M.
      Decreased incidence of headache after accidental dural puncture in caesarean delivery patients receiving continuous post-operative intrathecal analgesia.
      • Norris M.C.
      • Leighton B.L.
      Continous spinal anesthesia after unintentional dural puncture in parturients.
      • Paech M.
      • Banks S.
      • Gurrin L.
      An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients.
      • Rutter S.V.
      • Shields F.
      • Broadbent C.R.
      • Popat M.
      • Russell R.
      Management of accidental dural puncture in labour with intrathecal catheters: an analysis of 10 years’ experience.
      • Spiegel J.E.
      • Tsen L.C.
      • Segal S.
      Requirement for and success of epidural blood patch after intrathecal catheter placement for unintentional dural puncture.
      • Ayad S.
      • Demian Y.
      • Narouze S.N.
      • Tetzlaff J.E.
      Subarachnoid catheter placement after wet tap for analgesia in labor: influence on the risk of headache in obstetric patients.
      • Kaul B.
      • Debra S.
      • Vallejo M.C.
      • Derenzo J.
      • Jonathan W.
      A five years’ experience with post dural puncture headache.
      • Walters M.A.
      • van de Velde M.
      An update on the use of prolonged spinal catheter to prevent postural puncture headache after accidental dural puncture.
      • Russell I.F.
      A prospective controlled study of continuous spinal analgesia versus repeat epidural analgesia versus repeat epidural analgesia after accidental dural puncture in labour.
      • Kaddoum R.
      • Motlani F.
      • Kaddoum R.N.
      • Srirajakalidindi A.
      • Gupta D.
      • Soskin V.
      Accidental dural puncture, postdural puncture headache, intrathecal catheters, and epidural blood patch: revisiting the old nemesis.
      • Verstraete S.
      • Walters M.A.
      • Devroe S.
      • Roofthooft E.
      • Van de Velde M.
      Lower incidence of post-dural puncture headache with spinal catheterisation after accidental dural puncture in obstetric patients.
      • Antunes M.V.
      • Moreira A.
      • Sampaio C.
      • Faria A.
      Accidental dural puncture and post-dural puncture headache in the obstetric population: eight years of experience.
      • Bolden N.
      • Gebre E.
      Accidental dural puncture management: 10-year experience at an academic tertiary care center.
      • Jagannathan D.K.
      • Arriaga A.F.
      • Elterman K.G.
      • et al.
      Effect of neuraxial technique after inadvertent dural puncture on obstetric outcomes and anesthetic complications.
      • Tien J.C.
      • Lim M.J.
      • Leong W.L.
      • Lew E.
      Nine-year audit of post-dural puncture headache in a tertiary obstetric hospital in Singapore.
      • Tien M.
      • Peacher D.F.
      • Franz A.M.
      • Jia S.Y.
      • Habib A.S.
      Failure rate and complications associated with the use of spinal catheters for the management of inadvertent dural puncture in the parturient: a retrospective comparison with re-sited epidural catheters.
      • Deng J.
      • Wang L.
      • Zhang Y.
      • Chang X.
      • Ma X.
      Insertion of an intrathecal catheter in parturients reduces the risk of post-dural puncture headache: a retrospective study and meta-analysis.
      • Rana K.
      • Jenkins S.
      • Rana M.
      Insertion of an intrathecal catheter following a recognised accidental dural puncture reduces the need for an epidural blood patch in parturients: an Australian retrospective study.
      • Segal S.
      • Tsen L.C.
      • Datta S.
      Intrathecal catheter insertion following unintentional dural puncture reduces the requirement for epidural blood patch.
      were analysed. The abstract by Walters et al.
      • Walters M.A.
      • van de Velde M.
      An update on the use of prolonged spinal catheter to prevent postural puncture headache after accidental dural puncture.
      was updated in a full paper in 2014
      • Verstraete S.
      • Walters M.A.
      • Devroe S.
      • Roofthooft E.
      • Van de Velde M.
      Lower incidence of post-dural puncture headache with spinal catheterisation after accidental dural puncture in obstetric patients.
      so in our analyses we included the data coming from the 2014 report.
      • Verstraete S.
      • Walters M.A.
      • Devroe S.
      • Roofthooft E.
      • Van de Velde M.
      Lower incidence of post-dural puncture headache with spinal catheterisation after accidental dural puncture in obstetric patients.
      Similarly, the data published by Segal et al.
      • Segal S.
      • Tsen L.C.
      • Datta S.
      Intrathecal catheter insertion following unintentional dural puncture reduces the requirement for epidural blood patch.
      were updated by Spiegel et al.
      • Spiegel J.E.
      • Tsen L.C.
      • Segal S.
      Requirement for and success of epidural blood patch after intrathecal catheter placement for unintentional dural puncture.
      and we included this latter data. The papers by Paech et al.,
      • Paech M.
      • Banks S.
      • Gurrin L.
      An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients.
      Antunes et al.
      • Antunes M.V.
      • Moreira A.
      • Sampaio C.
      • Faria A.
      Accidental dural puncture and post-dural puncture headache in the obstetric population: eight years of experience.
      and Tien et al.
      • Tien J.C.
      • Lim M.J.
      • Leong W.L.
      • Lew E.
      Nine-year audit of post-dural puncture headache in a tertiary obstetric hospital in Singapore.
      were excluded because they combined the outcome data from catheters that were placed intrathecally after an accidental dural puncture was observed with data from catheters that were intended as epidural catheters and were only later identified to be positioned in the subarachnoid space. The study by Kaul et al.
      • Kaul B.
      • Debra S.
      • Vallejo M.C.
      • Derenzo J.
      • Jonathan W.
      A five years’ experience with post dural puncture headache.
      was excluded because the control group did not receive epidural replacement. Finally, we included 13 reports,
      • Cohen S.
      • Amar D.
      • Pantuck E.J.
      • Singer N.
      • Divon M.
      Decreased incidence of headache after accidental dural puncture in caesarean delivery patients receiving continuous post-operative intrathecal analgesia.
      • Norris M.C.
      • Leighton B.L.
      Continous spinal anesthesia after unintentional dural puncture in parturients.
      • Rutter S.V.
      • Shields F.
      • Broadbent C.R.
      • Popat M.
      • Russell R.
      Management of accidental dural puncture in labour with intrathecal catheters: an analysis of 10 years’ experience.
      • Spiegel J.E.
      • Tsen L.C.
      • Segal S.
      Requirement for and success of epidural blood patch after intrathecal catheter placement for unintentional dural puncture.
      • Ayad S.
      • Demian Y.
      • Narouze S.N.
      • Tetzlaff J.E.
      Subarachnoid catheter placement after wet tap for analgesia in labor: influence on the risk of headache in obstetric patients.
      • Russell I.F.
      A prospective controlled study of continuous spinal analgesia versus repeat epidural analgesia versus repeat epidural analgesia after accidental dural puncture in labour.
      • Kaddoum R.
      • Motlani F.
      • Kaddoum R.N.
      • Srirajakalidindi A.
      • Gupta D.
      • Soskin V.
      Accidental dural puncture, postdural puncture headache, intrathecal catheters, and epidural blood patch: revisiting the old nemesis.
      • Verstraete S.
      • Walters M.A.
      • Devroe S.
      • Roofthooft E.
      • Van de Velde M.
      Lower incidence of post-dural puncture headache with spinal catheterisation after accidental dural puncture in obstetric patients.
      • Bolden N.
      • Gebre E.
      Accidental dural puncture management: 10-year experience at an academic tertiary care center.
      • Jagannathan D.K.
      • Arriaga A.F.
      • Elterman K.G.
      • et al.
      Effect of neuraxial technique after inadvertent dural puncture on obstetric outcomes and anesthetic complications.
      • Tien M.
      • Peacher D.F.
      • Franz A.M.
      • Jia S.Y.
      • Habib A.S.
      Failure rate and complications associated with the use of spinal catheters for the management of inadvertent dural puncture in the parturient: a retrospective comparison with re-sited epidural catheters.
      • Deng J.
      • Wang L.
      • Zhang Y.
      • Chang X.
      • Ma X.
      Insertion of an intrathecal catheter in parturients reduces the risk of post-dural puncture headache: a retrospective study and meta-analysis.
      • Rana K.
      • Jenkins S.
      • Rana M.
      Insertion of an intrathecal catheter following a recognised accidental dural puncture reduces the need for an epidural blood patch in parturients: an Australian retrospective study.
      published between 1990
      • Norris M.C.
      • Leighton B.L.
      Continous spinal anesthesia after unintentional dural puncture in parturients.
      and 2018.
      • Rana K.
      • Jenkins S.
      • Rana M.
      Insertion of an intrathecal catheter following a recognised accidental dural puncture reduces the need for an epidural blood patch in parturients: an Australian retrospective study.
      The total number of patients included was 1653. Assessment of the methodological study quality is given in Tables 1a and 1b. Details of the studies are summarised in Table 2. There were insufficient demographic data given in the studies by Ayad et al.
      • Ayad S.
      • Demian Y.
      • Narouze S.N.
      • Tetzlaff J.E.
      Subarachnoid catheter placement after wet tap for analgesia in labor: influence on the risk of headache in obstetric patients.
      , Kaddoum et al.
      • Kaddoum R.
      • Motlani F.
      • Kaddoum R.N.
      • Srirajakalidindi A.
      • Gupta D.
      • Soskin V.
      Accidental dural puncture, postdural puncture headache, intrathecal catheters, and epidural blood patch: revisiting the old nemesis.
      and Rana et al.
      • Rana K.
      • Jenkins S.
      • Rana M.
      Insertion of an intrathecal catheter following a recognised accidental dural puncture reduces the need for an epidural blood patch in parturients: an Australian retrospective study.
      to determine whether the groups were similar at baseline.
      Figure thumbnail gr1
      Fig. 1Flow-chart of the selection of the included trials
      Table 1aNon-randomised-studies
      Norris, 1990
      • Norris M.C.
      • Leighton B.L.
      Continous spinal anesthesia after unintentional dural puncture in parturients.
      Risk of bias
      Pre-intervention
       Bias due to confoundingModerate risk
       Bias in selection of participants into the studyModerate risk
      At intervention
       Bias in classification of interventionsLow risk
      Post-intervention
       Bias due to deviations from intended interventionsModerate risk
       Bias due to missing dataLow risk
       Bias in measurement of outcomesSerious risk
       Bias in selection of the reported resultSerious risk
      Cohen, 1994
      • Cohen S.
      • Amar D.
      • Pantuck E.J.
      • Singer N.
      • Divon M.
      Decreased incidence of headache after accidental dural puncture in caesarean delivery patients receiving continuous post-operative intrathecal analgesia.
      Risk of bias
      Pre-intervention
       Bias due to confoundingLow risk
       Bias in selection of participants into the studyModerate risk
      At intervention
       Bias in classification of interventionsLow risk
      Post-intervention
       Bias due to deviations from intended interventionsModerate risk
       Bias due to missing dataLow risk
       Bias in measurement of outcomesLow risk
       Bias in selection of the reported resultLow risk
      Rutter, 2001
      • Rutter S.V.
      • Shields F.
      • Broadbent C.R.
      • Popat M.
      • Russell R.
      Management of accidental dural puncture in labour with intrathecal catheters: an analysis of 10 years’ experience.
      Risk of bias
      Pre-intervention
       Bias due to confoundingLow risk
       Bias in selection of participants into the studyModerate risk
      At intervention
       Bias in classification of interventionsLow risk
      Post-intervention
       Bias due to deviations from intended interventionsSerious risk
       Bias due to missing dataLow risk
       Bias in measurement of outcomesSerious risk
       Bias in selection of the reported resultLow risk
      Spiegel 2001
      • Spiegel J.E.
      • Tsen L.C.
      • Segal S.
      Requirement for and success of epidural blood patch after intrathecal catheter placement for unintentional dural puncture.
      Risk of bias
      Pre-intervention
       Bias due to confoundingLow risk
       Bias in selection of participants into the studyNo information
      At intervention
       Bias in classification of interventionsLow risk
      Post-intervention
       Bias due to deviations from intended interventionsNo information
       Bias due to missing dataLow risk
       Bias in measurement of outcomesNo information
       Bias in selection of the reported resultLow risk
      Ayad, 2003
      • Ayad S.
      • Demian Y.
      • Narouze S.N.
      • Tetzlaff J.E.
      Subarachnoid catheter placement after wet tap for analgesia in labor: influence on the risk of headache in obstetric patients.
      Risk of bias
      Pre-intervention
       Bias due to confoundingLow risk
       Bias in selection of participants into the studyLow risk
      At intervention
       Bias in classification of interventionsLow risk
      Post-intervention
       Bias due to deviations from intended interventionsModerate risk
       Bias due to missing dataLow risk
       Bias in measurement of outcomesLow risk
       Bias in selection of the reported resultLow risk
      Kaddoum, 2014
      • Kaddoum R.
      • Motlani F.
      • Kaddoum R.N.
      • Srirajakalidindi A.
      • Gupta D.
      • Soskin V.
      Accidental dural puncture, postdural puncture headache, intrathecal catheters, and epidural blood patch: revisiting the old nemesis.
      Risk of bias
      Pre-intervention
       Bias due to confoundingLow risk
       Bias in selection of participants into the studyModerate risk
      At intervention
       Bias in classification of interventionsLow risk
      Post-intervention
       Bias due to deviations from intended interventionsLow risk
       Bias due to missing dataLow risk
       Bias in measurement of outcomesModerate risk
       Bias in selection of the reported resultModerate risk
      Verstraete, 2014
      • Verstraete S.
      • Walters M.A.
      • Devroe S.
      • Roofthooft E.
      • Van de Velde M.
      Lower incidence of post-dural puncture headache with spinal catheterisation after accidental dural puncture in obstetric patients.
      Risk of bias
      Pre-intervention
       Bias due to confoundingLow risk
       Bias in selection of participants into the studyModerate risk
      At intervention
       Bias in classification of interventionsLow risk
      Post-intervention
       Bias due to deviations from intended interventionsModerate risk
       Bias due to missing dataLow risk
       Bias in measurement of outcomesLow risk
       Bias in selection of the reported resultLow risk
      Bolden, 2016
      • Bolden N.
      • Gebre E.
      Accidental dural puncture management: 10-year experience at an academic tertiary care center.
      Risk of bias
      Pre-intervention
       Bias due to confoundingLow risk
       Bias in selection of participants into the studyModerate risk
      At intervention
       Bias in classification of interventionsModerate risk
      Post-intervention
       Bias due to deviations from intended interventionsModerate risk
       Bias due to missing dataLow risk
       Bias in measurement of outcomesModerate risk
       Bias in selection of the reported resultLow risk
      Jagannathan, 2016
      • Jagannathan D.K.
      • Arriaga A.F.
      • Elterman K.G.
      • et al.
      Effect of neuraxial technique after inadvertent dural puncture on obstetric outcomes and anesthetic complications.
      Risk of bias
      Pre-intervention
       Bias due to confoundingLow risk
       Bias in selection of participants into the studyModerate risk
      At intervention
       Bias in classification of interventionsLow risk
      Post-intervention
       Bias due to deviations from intended interventionsLow risk
       Bias due to missing dataLow risk
       Bias in measurement of outcomesLow risk
       Bias in selection of the reported resultLow risk
      Tien, 2016
      • Tien M.
      • Peacher D.F.
      • Franz A.M.
      • Jia S.Y.
      • Habib A.S.
      Failure rate and complications associated with the use of spinal catheters for the management of inadvertent dural puncture in the parturient: a retrospective comparison with re-sited epidural catheters.
      Risk of bias
      Pre-intervention
       Bias due to confoundingMedium risk
       Bias in selection of participants into the studyModerate risk
      At intervention
       Bias in classification of interventionsLow risk
      Post-intervention
       Bias due to deviations from intended interventionsModerate risk
       Bias due to missing dataModerate risk
       Bias in measurement of outcomesModerate risk
       Bias in selection of the reported resultLow risk
      Deng, 2017
      • Deng J.
      • Wang L.
      • Zhang Y.
      • Chang X.
      • Ma X.
      Insertion of an intrathecal catheter in parturients reduces the risk of post-dural puncture headache: a retrospective study and meta-analysis.
      Risk of bias
      Pre-intervention
       Bias due to confoundingLow risk
       Bias in selection of participants into the studyModerate risk
      At intervention
       Bias in classification of interventionsLow risk
      Post-intervention
       Bias due to deviations from intended interventionsModerate risk
       Bias due to missing dataLow risk
       Bias in measurement of outcomesNo information
       Bias in selection of the reported resultModerate risk
      Rana, 2018
      • Rana K.
      • Jenkins S.
      • Rana M.
      Insertion of an intrathecal catheter following a recognised accidental dural puncture reduces the need for an epidural blood patch in parturients: an Australian retrospective study.
      Risk of bias
      Pre-intervention
       Bias due to confoundingLow risk
       Bias in selection of participants into the studyModerate risk
      At intervention
       Bias in classification of interventionsModerate risk
      Post-intervention
       Bias due to deviations from intended interventionsModerate risk
       Bias due to missing dataLow risk
       Bias in measurement of outcomesLow risk
       Bias in selection of the reported resultLow risk
      Table 1bRandomised study


      Russell, 2012
      • Russell I.F.
      A prospective controlled study of continuous spinal analgesia versus repeat epidural analgesia versus repeat epidural analgesia after accidental dural puncture in labour.
      Risk of bias
      Random sequence generationLow risk
      Allocation concealmentHigh risk
      Blinding of participants and personnelHigh risk
      Blinding of outcome assessmentHigh risk
      Incomplete outcome dataLow risk
      Selective reportingUnclear risk
      Other biasHigh risk
      Table 2Study details
      Number of casesType of studyType of deliveryInterventionControlITC effects
      Norris
      • Norris M.C.
      • Leighton B.L.
      Continous spinal anesthesia after unintentional dural puncture in parturients.
      56Prospectivex35 spinal catheter in situ >2 h after delivery21 epidural catheter resitedNo
      Cohen
      • Cohen S.
      • Amar D.
      • Pantuck E.J.
      • Singer N.
      • Divon M.
      Decreased incidence of headache after accidental dural puncture in caesarean delivery patients receiving continuous post-operative intrathecal analgesia.
      45Retrospectivecaesarean17 spinal catheter removed after caesarean

      13 spinal catheter in situ 24 h after caesarean
      15 epidural catheter resitedYes. Reduced EBP spinal catheter in situ 24 h
      Rutter
      • Rutter S.V.
      • Shields F.
      • Broadbent C.R.
      • Popat M.
      • Russell R.
      Management of accidental dural puncture in labour with intrathecal catheters: an analysis of 10 years’ experience.
      71Retrospective49 vaginal (25 ITC, 24 epidural)

      8 caesarean (9 ITC, 9 epidural)
      34 spinal catheter hours in situ unknown37 epidural catheter resitedNo
      Spiegel
      Only abstract available. X no details available. ITC: intrathecal catheterisation; PDPH: post-dural puncture headache; EBP: epidural blood patch.
      • Spiegel J.E.
      • Tsen L.C.
      • Segal S.
      Requirement for and success of epidural blood patch after intrathecal catheter placement for unintentional dural puncture.
      154Retrospectivex102 spinal catheter in situ 24 h after delivery52 epidural catheter resitedNo
      Ayad
      • Ayad S.
      • Demian Y.
      • Narouze S.N.
      • Tetzlaff J.E.
      Subarachnoid catheter placement after wet tap for analgesia in labor: influence on the risk of headache in obstetric patients.
      103Retrospectivevaginal35 spinal catheter removed after delivery

      31 spinal catheter in situ 24 h after delivery
      37 epidural catheter resitedYes. Reduced PDPH (if 24 h in situ more than if removed after delivery)
      Russell
      • Russell I.F.
      A prospective controlled study of continuous spinal analgesia versus repeat epidural analgesia versus repeat epidural analgesia after accidental dural puncture in labour.
      97Prospectivex50 spinal catheter in situ 24–36 h after delivery47 epidural catheter resitedNo
      Kaddoum
      • Kaddoum R.
      • Motlani F.
      • Kaddoum R.N.
      • Srirajakalidindi A.
      • Gupta D.
      • Soskin V.
      Accidental dural puncture, postdural puncture headache, intrathecal catheters, and epidural blood patch: revisiting the old nemesis.
      238Retrospectivex54 spinal catheter in situ 24 h after delivery184 epidural catheter resitedYes. Reduced PDPH
      Verstraete
      • Verstraete S.
      • Walters M.A.
      • Devroe S.
      • Roofthooft E.
      • Van de Velde M.
      Lower incidence of post-dural puncture headache with spinal catheterisation after accidental dural puncture in obstetric patients.
      128Retrospectivecaesarean vaginal

      fetal surgery

      uterine artery

      embolisation
      89 spinal catheter in situ >24 h after delivery39 epidural catheter resitedYes. Reduced PDPH
      Bolden
      • Bolden N.
      • Gebre E.
      Accidental dural puncture management: 10-year experience at an academic tertiary care center.
      218Retrospectivex118 spinal catheter

       45 in situ 0–9 h after delivery

       14 in situ 10–19 h after delivery

       59 in situ 20–30 h after delivery
      100 epidural catheter resitedYes. Reduced EBP
      Jagannathan
      • Jagannathan D.K.
      • Arriaga A.F.
      • Elterman K.G.
      • et al.
      Effect of neuraxial technique after inadvertent dural puncture on obstetric outcomes and anesthetic complications.
      236Retrospectivevaginal

      caesarean
      173 spinal catheter, catheter removed 30–60 min after delivery63 epidural catheter resitedNo
      Tien
      • Tien M.
      • Peacher D.F.
      • Franz A.M.
      • Jia S.Y.
      • Habib A.S.
      Failure rate and complications associated with the use of spinal catheters for the management of inadvertent dural puncture in the parturient: a retrospective comparison with re-sited epidural catheters.
      109Retrospectivevaginal

      caesarean
      79 spinal catheter in situ median 24.1 h (IQR 13.0–26.2) after delivery30 epidural catheter resitedNo
      Deng
      • Deng J.
      • Wang L.
      • Zhang Y.
      • Chang X.
      • Ma X.
      Insertion of an intrathecal catheter in parturients reduces the risk of post-dural puncture headache: a retrospective study and meta-analysis.
      86Retrospectivevaginal

      caesarean
      47 spinal catheter39 epidural catheter resitedYes. Reduced EBP
      Rana
      • Rana K.
      • Jenkins S.
      • Rana M.
      Insertion of an intrathecal catheter following a recognised accidental dural puncture reduces the need for an epidural blood patch in parturients: an Australian retrospective study.
      94Retrospectivex66 spinal catheter

       37 in situ >24 h after delivery

       22 in situ <24 h after delivery

       7 in situ unknown hours
      28 epidural catheter resitedYes. Reduced EBP
      * Only abstract available. X no details available. ITC: intrathecal catheterisation; PDPH: post-dural puncture headache; EBP: epidural blood patch.
      Conventional meta-analysis of the incidence of PDPH and the need for EBP are shown in Figs. 2a and 2b. There was a statistically significant reduction in both parameters in the ITC group when compared to with the epidural catheter re-site group.
      Figure thumbnail gr2a
      Fig. 2aMeta-analysis of the incidence of post-dural puncture headache
      Figure thumbnail gr2b
      Fig. 2bMeta-analysis of the need for epidural blood patch
      Analysis of six studies showed that there was no significant difference in the risk of caesarean section (RR 1.03, 95%CI 0.78 to 1.35; I2=0%). Heterogeneity in our analyses was high, as reflected by significantly elevated I2 values. To explore the reasons for heterogeneity we performed a sensitivity analysis, excluding the randomised study by Russell et al.
      • Russell I.F.
      A prospective controlled study of continuous spinal analgesia versus repeat epidural analgesia versus repeat epidural analgesia after accidental dural puncture in labour.
      and including solely the observational studies. The analysis of the observational studies showed a significant difference between the two treatment groups for both outcomes, PDPH and need for EBP (data not shown). The difference between ITC and a re-sited epidural catheter for the need for an EBP was not significant in the randomised trial by Russell et al.
      • Russell I.F.
      A prospective controlled study of continuous spinal analgesia versus repeat epidural analgesia versus repeat epidural analgesia after accidental dural puncture in labour.
      Figs. 3a and 3b give the TSAs for the incidence of PDPH and the need for an EBP, respectively. Neither in the analysis of PDPH nor in that of EBP was the monitoring boundary or futility boundary crossed. There was thus insufficient evidence to corroborate the findings of the conventional meta-analyses.
      Figure thumbnail gr3a
      Fig. 3aTrial-sequential analysis of the incidence of post-dural puncture headache
      Figure thumbnail gr3b
      Fig. 3bTrial-sequential analysis of the need for epidural blood patch
      Figs. 4a and 4b show the contour-enhanced funnel plots for the two outcomes evaluated; they were symmetric, suggesting that there is no publication bias.
      Figure thumbnail gr4a
      Fig. 4aContour-enhanced funnel plot of the incidence of post-dural puncture headache
      Figure thumbnail gr4b
      Fig. 4bContour-enhanced funnel plot of the need for epidural blood patch
      The quality of analgesia was reported in several studies. The results are given in Table 3; the summary RR for adequate analgesia was 1.05 (95%CI 0.83 to 1.32). Russell et al.
      • Russell I.F.
      A prospective controlled study of continuous spinal analgesia versus repeat epidural analgesia versus repeat epidural analgesia after accidental dural puncture in labour.
      reported successful spinal analgesia in 50/57 of their ITC group. Seven patients had an epidural catheter re-sited, of which one patient developed a total spinal block. In the repeat epidural group (n=58) there were four spinal catheters placed, among which four parturients had spinal analgesia after the second dural puncture and one did not have an epidural catheter inserted.
      Table 3Quality of analgesia
      StudyDescription of analgesiaITCEDARemarksRR (95%CI)
      Spiegel
      • Spiegel J.E.
      • Tsen L.C.
      • Segal S.
      Requirement for and success of epidural blood patch after intrathecal catheter placement for unintentional dural puncture.
      acceptable analgesia91/10224/52P < 0.00011.93 [1.43 to 2.61]
      Rutter
      • Rutter S.V.
      • Shields F.
      • Broadbent C.R.
      • Popat M.
      • Russell R.
      Management of accidental dural puncture in labour with intrathecal catheters: an analysis of 10 years’ experience.
      inadequate block3/344/370.82 [0.20 to 3.39]
      adequate analgesia31/3433/371.02 [0.88 to 1.19]
      Norris
      • Norris M.C.
      • Leighton B.L.
      Continous spinal anesthesia after unintentional dural puncture in parturients.
      satisfactory/adequate pain relief32/3521/210.92 [0.82 to 1.05]
      Tien
      • Tien M.
      • Peacher D.F.
      • Franz A.M.
      • Jia S.Y.
      • Habib A.S.
      Failure rate and complications associated with the use of spinal catheters for the management of inadvertent dural puncture in the parturient: a retrospective comparison with re-sited epidural catheters.
      inadequate analgesia17/794/30P=0.331.61 [0.59 to 4.41]
      required iv analgesics2/790/301.94 [0.10 to 39.23]
      required other neuraxial15/794/301.42 [0.51 to 3.95]
      adequate analgesia62/7926/300.91 [0.76 to 1.09]
      Jagannathan
      • Jagannathan D.K.
      • Arriaga A.F.
      • Elterman K.G.
      • et al.
      Effect of neuraxial technique after inadvertent dural puncture on obstetric outcomes and anesthetic complications.
      failed labour analgesia resulting in the need for catheter replacement25/1731/639.10 [1.26 to 65.80]
      adequate analgesia148/17362/630.87 [0.81 to 0.93]
      ITC: intrathecal catheterization; EDA: epidural analgesia; iv: intravenous.
      Regarding side-effects, Cohen et al.
      • Cohen S.
      • Amar D.
      • Pantuck E.J.
      • Singer N.
      • Divon M.
      Decreased incidence of headache after accidental dural puncture in caesarean delivery patients receiving continuous post-operative intrathecal analgesia.
      reported that all patients who had an intrathecal catheter inserted for >24 h could easily ambulate within 12–24 h of delivery, and there were no cases of sensory loss, weakness, nausea, vomiting, pruritus, sedation, urinary retention or a respiratory rate <12 breaths/min; and no cases of neurological symptoms or signs of infection.
      Tien et al.
      • Tien M.
      • Peacher D.F.
      • Franz A.M.
      • Jia S.Y.
      • Habib A.S.
      Failure rate and complications associated with the use of spinal catheters for the management of inadvertent dural puncture in the parturient: a retrospective comparison with re-sited epidural catheters.
      reported that among the spinal catheter group of 79 patients, 7 (9%) experienced complications with one patient having a block higher than T1 bilaterally, five patients having hypotension, and two fetuses having bradycardia. Among the epidural re-site group of 30 patients, two had hypotension. No neurologic or infectious complications were observed. The difference in complications (9% versus 7% in the ITC versus the epidural catheter re-site groups) was not significantly different.

      Discussion

      Compared to our meta-analysis of 2013
      • Heesen M.
      • Klöhr S.
      • Rossaint R.
      • Walters M.
      • Straube S.
      • van de Velde M.
      Insertion of an intrathecal catheter following accidental dural puncture: a meta-analysis.
      we identified seven additional studies published since then, contributing data from an additional 1109 patients. The total number of patients in our analysis was 1653. Our conventional meta-analyses found statistically significant reductions in the incidence of PDPH and in the need for EBP in the ITC group. However, these findings were not corroborated in the respective TSAs.
      While we were planning our study, a similar meta-analysis was published by Deng et al.
      • Deng J.
      • Wang L.
      • Zhang Y.
      • Chang X.
      • Ma X.
      Insertion of an intrathecal catheter in parturients reduces the risk of post-dural puncture headache: a retrospective study and meta-analysis.
      These authors included 13 studies with 1044 patients and found a significant reduction in the incidence of PDPH and in the need for EBP in the ITC group. They also presented the original data of a cohort of women receiving ITC or an epidural re-site in which the incidence of PDPH was not significantly different in the ITC group. However, Deng et al.
      • Deng J.
      • Wang L.
      • Zhang Y.
      • Chang X.
      • Ma X.
      Insertion of an intrathecal catheter in parturients reduces the risk of post-dural puncture headache: a retrospective study and meta-analysis.
      did not include their original data in their meta-analysis. There are several differences from our meta-analysis. Firstly, we included the original data by Deng et al.
      • Deng J.
      • Wang L.
      • Zhang Y.
      • Chang X.
      • Ma X.
      Insertion of an intrathecal catheter in parturients reduces the risk of post-dural puncture headache: a retrospective study and meta-analysis.
      Secondly, we studied 13 reports with 1653 patients compared to 1044 patients in the meta-analysis by Deng et al.,
      • Deng J.
      • Wang L.
      • Zhang Y.
      • Chang X.
      • Ma X.
      Insertion of an intrathecal catheter in parturients reduces the risk of post-dural puncture headache: a retrospective study and meta-analysis.
      Thirdly, we excluded the studies by Paech et al.
      • Paech M.
      • Banks S.
      • Gurrin L.
      An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients.
      and Antunes et al.
      • Antunes M.V.
      • Moreira A.
      • Sampaio C.
      • Faria A.
      Accidental dural puncture and post-dural puncture headache in the obstetric population: eight years of experience.
      because they included unrecognised dural punctures. Finally, and most importantly, we added a TSA which showed that the accrued evidence was not sufficient to exclude a false-positive result. A TSA considers meta-analyses as updates, analogous to interim analyses in single trials, and applies the techniques for repeated statistical testing that are used in randomised clinical trials to meta-analysis.
      • Spiegel J.E.
      • Tsen L.C.
      • Segal S.
      Requirement for and success of epidural blood patch after intrathecal catheter placement for unintentional dural puncture.
      • Ayad S.
      • Demian Y.
      • Narouze S.N.
      • Tetzlaff J.E.
      Subarachnoid catheter placement after wet tap for analgesia in labor: influence on the risk of headache in obstetric patients.
      • Kaul B.
      • Debra S.
      • Vallejo M.C.
      • Derenzo J.
      • Jonathan W.
      A five years’ experience with post dural puncture headache.
      • Walters M.A.
      • van de Velde M.
      An update on the use of prolonged spinal catheter to prevent postural puncture headache after accidental dural puncture.
      • Russell I.F.
      A prospective controlled study of continuous spinal analgesia versus repeat epidural analgesia versus repeat epidural analgesia after accidental dural puncture in labour.
      Monitoring boundaries are constructed in order to maintain overall risks of random error at the 5% level. Imberger et al.
      • Imberger G.
      • Gluud C.
      • Boylan J.
      • Wetterslev J.
      Systematic reviews of anesthesiologic interventions reported as statistically significant: problems with power, precision, and type 1 error protection.
      demonstrated that TSA has added value, compared to conventional meta-analyses alone, by reducing the risk of false results.
      Unfortunately, we had not yet established this technique when we performed our first meta-analysis on this topic in 2013; in this conventional meta-analysis only (without TSA), we found a significant reduction in the incidence of EBP but not of the incidence of PDPH.
      • Heesen M.
      • Klöhr S.
      • Rossaint R.
      • Walters M.
      • Straube S.
      • van de Velde M.
      Insertion of an intrathecal catheter following accidental dural puncture: a meta-analysis.
      There are studies that found an effect on PDPH
      • Ayad S.
      • Demian Y.
      • Narouze S.N.
      • Tetzlaff J.E.
      Subarachnoid catheter placement after wet tap for analgesia in labor: influence on the risk of headache in obstetric patients.
      or EBP
      • Cohen S.
      • Amar D.
      • Pantuck E.J.
      • Singer N.
      • Divon M.
      Decreased incidence of headache after accidental dural puncture in caesarean delivery patients receiving continuous post-operative intrathecal analgesia.
      when the intrathecal catheters were retained for 24 h compared to those that were removed immediately after delivery. However, the studies that did not show an effect of ITC and a non-significant risk ratio (although favouring the epidural re-site technique) had an intrathecal catheter residence time of 24 or more hours (studies led by Norris
      • Norris M.C.
      • Leighton B.L.
      Continous spinal anesthesia after unintentional dural puncture in parturients.
      , Russell
      • Russell I.F.
      A prospective controlled study of continuous spinal analgesia versus repeat epidural analgesia versus repeat epidural analgesia after accidental dural puncture in labour.
      , and Tien
      • Tien M.
      • Peacher D.F.
      • Franz A.M.
      • Jia S.Y.
      • Habib A.S.
      Failure rate and complications associated with the use of spinal catheters for the management of inadvertent dural puncture in the parturient: a retrospective comparison with re-sited epidural catheters.
      for the outcome PDPH; Tien
      • Tien M.
      • Peacher D.F.
      • Franz A.M.
      • Jia S.Y.
      • Habib A.S.
      Failure rate and complications associated with the use of spinal catheters for the management of inadvertent dural puncture in the parturient: a retrospective comparison with re-sited epidural catheters.
      for the outcome EBP). So, the time an intrathecal catheter needs to be left in situ requires further research, as do the risks of longer in situ times including infection and accidental drug administration.
      Heterogeneity in our analyses was high and requires comment. Our sensitivity analysis showed that the difference between the two treatments was significant in the observational studies but not in the prospective study by Russell et al.
      • Russell I.F.
      A prospective controlled study of continuous spinal analgesia versus repeat epidural analgesia versus repeat epidural analgesia after accidental dural puncture in labour.
      Those authors classified their trial as randomised, although the randomisation was done per participating centre and not per patient and, thus, the risks for selection bias (no allocation concealment), performance bias (no blinding of patients and personnel), and detection bias (no blinding of the outcome assessor) were high. We, therefore, cannot conclude that a higher level of evidence comes from the study by Russell et al.
      • Russell I.F.
      A prospective controlled study of continuous spinal analgesia versus repeat epidural analgesia versus repeat epidural analgesia after accidental dural puncture in labour.
      and that this evidence suggests a lack of effect from ITC. Other reasons accounting for heterogeneity include the criteria for blood patching and the frequency and duration of patient follow-up.
      There are several limitations of our study and of the use of intrathecal catheters. Firstly, we included abstracts which, due to space restrictions, may not report all the items that are screened with the quality assessment tool. Accordingly, the reporting quality of the abstracts was lower than the quality of full papers. We cannot be sure that we did not miss abstracts as they may not have been retrieved by our search.
      Secondly, only two studies reported complications, such that no meaningful conclusions can be drawn about side-effects.
      • Cohen S.
      • Amar D.
      • Pantuck E.J.
      • Singer N.
      • Divon M.
      Decreased incidence of headache after accidental dural puncture in caesarean delivery patients receiving continuous post-operative intrathecal analgesia.
      • Tien M.
      • Peacher D.F.
      • Franz A.M.
      • Jia S.Y.
      • Habib A.S.
      Failure rate and complications associated with the use of spinal catheters for the management of inadvertent dural puncture in the parturient: a retrospective comparison with re-sited epidural catheters.
      We found case reports describing a subdural haematoma,
      • Green M.S.
      • George S.
      • Green P.
      • Kzmi K.
      Subdural hematoma following labor analgesia utilizing an intrathecal catheter.
      meningitis,
      • Cohen S.
      • Hunter C.W.
      • Sakr A.
      • Hijazi R.H.
      Meningitis following intrathecal catheter placement after accidental dural puncture.
      and tinnitus
      • Ravi R.
      Isolated tinnitus following placement of an intrathecal catheter for accidental dural puncture.
      after ITC and the safety of this procedure has been questioned.
      • Rosenblatt M.A.
      • Bernstein H.H.
      • Beilin Y.
      Are subarachnoid catheters really safe?.
      There is, however, a large study reporting that among 761 obstetric cases receiving intrathecal catheters there were three high blocks and one case of respiratory depression.
      • Cohn J.
      • Moaveni D.
      • Sznol J.
      • Ranasinghe J.
      Complications of 761 short-term intrathecal macrocatheters in obstetric patients: a retrospective review of cases over a 12-year period.
      No serious neurologic complications (including meningitis, epidural or spinal abscess, haematoma, arachnoiditis, or cauda equina syndrome) were observed.
      • Cohn J.
      • Moaveni D.
      • Sznol J.
      • Ranasinghe J.
      Complications of 761 short-term intrathecal macrocatheters in obstetric patients: a retrospective review of cases over a 12-year period.
      In addition, concerns regarding drug errors into intrathecal catheters have been expressed,
      • Ramaswamy K.K.
      • Burumdayal A.
      • Bhardwaj M.
      • Russell R.
      A UK survey of the management of intrathecal catheters.
      and proper labelling as well as protocols for the use of the intrathecal catheter appear of pivotal importance to patient safety.
      Thirdly, in the studies in our review some authors removed the intrathecal catheter immediately after delivery whereas others left the catheter in situ for greater than 24 h. It remains unclear whether leaving the catheter in situ for a longer period has a beneficial effect.
      • Blaise G.A.
      • Cournoyer S.
      • Perrault C.
      • Bedard M.J.
      • Petit F.
      Spinal catheter does not reduce post-dural puncture headache after caesarean section.
      Blaise et al. found no decrease in the percentage of PDPH nor in the need for EBP with a 24 h in situ time. In contrast, in a small case series no case of postural headache was observed after overnight catheterisation for 13–19 h.
      • Dennehy K.C.
      • Rosaeg O.P.
      Intrathecal catheter insertion during labour reduces the risk of postdural puncture headache.
      Advocates of longer catheterisation times suggest that an inflammatory reaction will develop to help plug the dural and arachnoid tear.
      • Nath G.
      • Subrahmanyam M.
      Headache in the parturient: Pathophysiology and management of postdural puncture headache.
      Given the large number of cases that would be necessary to achieve the required information size, it is unlikely that a sufficiently powered prospective study of high methodological quality will ever be conducted. The number of anaesthetists choosing ITC instead of epidural re-siting has significantly risen over the years, from 28% of UK labour units in 2005
      • Baraz R.
      • Collis R.E.
      The management of accidental dural puncture during labour epidural analgesia: a survey of UK practice.
      to 48% in 2013.
      • Ramaswamy K.K.
      • Burumdayal A.
      • Bhardwaj M.
      • Russell R.
      A UK survey of the management of intrathecal catheters.
      We cannot ignore that this meta-analysis and TSA may have an impact on clinical practice, in that practitioners will abstain from performing ITCs due to the lack of convincing evidence for their benefit. Therefore, we call for an evidence-based practice guideline that gives a balanced view and considers the putative benefits versus the possible risks of ITCs (including the rare side effects) and that informs clinical practice with regard to the time period over which the ITC should be in place, the use of the ITC for analgesia (and the analgesics that should be administered) and the management of complications.

      Declaration of interests

      All authors have nothing to disclose.

      Funding

      Departmental funding only.

      Acknowledgements

      We would like to thank Ms. M. Gosteli, University Library, University of Zurich , Switzerland for her support with the systematic electronic literature search.

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