Accidental dural puncture during epidural placement in obstetric patients occurs in 0.4%–1.5% of cases and can result in complications such as post-dural puncture headache (PDPH) and inadequate analgesia. Management options include resiting the epidural or threading an intrathecal catheter (ITC). ITCs offer rapid pain relief, avoid repeated dural punctures, and facilitate surgical anaesthesia if needed. However, they carry risks such as high spinal anaesthesia, drug administration errors, and infection. Clear labelling, aseptic technique, and close maternal and fetal parameters monitoring are essential for safe ITC use. Institutions should establish protocols to guide intrathecal catheter management, including dosing regimens and removal strategies to prevent complications. Recommended dosages include bupivacaine 1.25–2.5 mg with fentanyl for labour analgesia and titrated boluses of bupivacaine for surgical anaesthesia. Safety measures include continuous blood pressure monitoring, fetal heart rate assessment, and multidisciplinary communication. While ITCs may reduce PDPH incidence, patient follow-up is necessary to monitor complications. This article outlines best practices for ITC use in obstetric anaesthesia, emphasizing patient safety, effective pain management, and institutional guidelines to standardize care and minimize medicolegal risks.