Post labor epidural analgesia spinal bubbles.
Abstract Number: F-45
Abstract Type: Case Report/Case Series
Background: Epidural analgesia is frequently utilized during labour and delivery. Our hospital has about 14,500 deliveries per year; of those around 60% receive epidural analgesia. Placement of the epidural catheter can be confirmed by the loss of resistance method, with a saline or air filled syringe. Postdural puncture headache is a well known complication of dural puncture. Inadvertent injection of air into the CSF space though is a much rarer and less described complication.
Patients and methods: We collected all cases of air bubbles (pneumocephalus) which were diagnosed by us over a 3 year period.
Results: We describe the cases of 5 women, who underwent epidural anesthesia for delivery and suffered from different neurological complications after delivery, which included myelopathy in one patient, lumbar radiculopathy (1), headache with neck stiffness (1) and severe head- and back pain (2). The neurological complaints were due to spinal or intraventricular air bubbles, probably introduced during the insertion of the epidural catheter. Non contrast CT enabled diagnosis in all cases. In all 5, the symptoms resolved completely and without specific treatment after two days.
Conclusion: Though rare, the complication of air bubbles in the CSF should be diagnosed. The presentation can be dramatic and include neurological deficits, but the prognosis seems to be excellent. It should be remembered that nitrous oxide inhalation will increase size of the air bubbles and should be avoided in patients whose epidural anesthesia was performed with the air technique.