I performed 2 inadvertant dural punctures at 3cm on an elderly lady (heavy smoker)  in separate spaces, following a laparotomy, whilst still intubated.The tap was discovered on both occasions by negative aspiration by a 2ml syringe, no CSF came through the Touhy needle. After the second, I decided to administer intrathecal diamorhpine 0.25mg and plain marcaine 2.5 mls before I withdrew the catheter, for postoperative analgesia. 3 minutes later she became profoundly bradycardic, hypotensive and had a repsiratory arrest. Atropine 600mcg and Naloxone 300mcg was adinistered IV, after which her heart rate, blood pressure and respiratory rate recovered. She awakened sufficiently to start going for her ETT and so I extubated her and sent her to HDU for careful post-op monitoring. Her analgesia was good immediately postoperatively.
Have many people administetred intrathecal analgesia in such patients after inadvertant dural punctures? I know it is done frequently in obstetrics, but have little knowledge of this in the elderly. If anyone has done it, any recipes for a more successful outcome?!