Pneumocephalus After Dural Puncture During Epidural Analgesia: A Case Report

Lumbar epidural anesthesia is commonly used for labor analgesia. The 'loss-of- resistance' to air technique (LORA) is generally employed for recognition of the epidural space. One of the rare complications of this technique is pneumocephalus (PC). Here we describe the case of a parturient who developed a frontal headache when locating the epidural space using LORA. On the second day after epidural injection, the patient exhibited occipital headaches with gradual worsening. Computed tomography scans of the brain indicated PC. Following symptomatic treatment, our patient was discharged on the 13th day. We concluded that the amount of air used to identify the epidural space in LORA should be minimized, LORA should not be used after dural puncture and the use of saline avoids PC complications.

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Subdural Hematoma following Accidental Dural Puncture while Performing Epidural Analgesia - A Case Report

International Journal of Contemporary Medical Research [IJCMR] ◽

10.21276/ijcmr.2019.6.3.23 ◽

2019 ◽

Vol 6 (3) ◽

Author(s):

Noor Ghanim Abdullah Aldhahri ◽

Rashid M Khan ◽

Naresh Kaul ◽

Abdullah Al-Jadidi

Keyword(s):

Case Report ◽

Epidural Analgesia ◽

Subdural Hematoma ◽

Dural Puncture ◽

Accidental Dural Puncture

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A pilot study comparing dural puncture epidural with 27G Whitacre needle and conventional lumbar epidural labor analgesia

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-021-00178-y ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Ashok Jadon ◽

Surabhi Srivastawa ◽

Neelam Sinha ◽

Swastika Chakraborty ◽

Apoorva Bakshi ◽

...

Keyword(s):

Side Effects ◽

Epidural Analgesia ◽

Dural Puncture ◽

Mode Of Delivery ◽

Labor Analgesia ◽

Labor Pain ◽

Spinal Needle ◽

Lumbar Epidural Analgesia ◽

A New Technique ◽

Dural Puncture Epidural

Abstract Background The dural puncture epidural (DPE) technique is relatively a new technique of labor analgesia and has been advocated with the advantage of faster onset of pain relief. However, there are differences of opinion regarding the efficacy of the DPE technique and the size of the spinal needle to be used for the DPE. Various studies have suggested that DPE can only be done with a larger gauge of a spinal needle; however, recent studies have variable observations. We have compared the conventional lumbar epidural analgesia and DPE using a 27G pencil-point needle to assess the efficacy of DPE and its possible side effects. Results The time to achieve a 50% reduction in VAS was 7.06 ± 0.79 min in group CLE (n = 15) and 5.0 ± 1.06 min in group DPE (n = 15) (difference of two means was 2.06, 95% CI [1.36, 2.75], t = 5.99, p < 0.0001). The time to achieve VAS < 3 in group CLE was 14.93 ± 1.98 min, and in the group DPE, it was 10.13 ± 1.45 min (difference of two means was 4.8, 95% CI [3.52, 6.09], t = 7.55, p < 0.0001). The mode of delivery, APGAR scores, and side effects were comparable (p > 0.05). Conclusions DPE provided faster relief of labor pain than the conventional labor epidural analgesia. There were no added side effects by DPE in conventional lumbar epidural analgesia for labor. A 27G Whitacre pencil-point needle can be used for DPE. Trial registration CTRI, CTRI/2020/08/027060. Registered on 10/08/2020. Trial registered prospectively. CTRI website URL: http://ctri.nic.in

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Myoclonus-like involuntary movements under subarachnoid block completely subsided after midazolam administration in a patient undergoing cesarean section: a case report

10.7287/peerj.preprints.101 ◽

2013 ◽

Author(s):

Kiichi Hirota

Keyword(s):

Case Report ◽

Side Effects ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Epidural Anesthesia ◽

Involuntary Movement ◽

Upper Extremities ◽

Spontaneous Pain ◽

Subarachnoid Block ◽

Involuntary Movements

Involuntary movement during and after neuraxial anesthesia, such as spinal and epidural anesthesia, is rarely observed. In this report, we describe a case of myoclonus-like involuntary movement of the upper extremities in a patient undergoing a planned repeat cesarean section under spinal anesthesia with bupivacaine that completely subsided after 2mg midazolam administration. The myoclonus-like movement never recurred or caused any apparent neurological side effects. No abnormal sensation or spontaneous pain of the upper extremities was observed. The patient was discharged on foot on post-operative day 3.

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Horner’s Syndrome with Unilateral Brachial Plexus Blockade Mimicking Cerebrovascular Accident Following Lumbar Combined Spinal Epidural Analgesia for Labor

Military Medicine ◽

10.1093/milmed/usz160 ◽

2019 ◽

Author(s):

Richard J Bennett ◽

Amy Wooten ◽

Lee Babbel ◽

Bradley A Reel

Keyword(s):

Epidural Analgesia ◽

Brachial Plexus ◽

Epidural Anesthesia ◽

Cerebrovascular Accident ◽

Expectant Management ◽

Horner’S Syndrome ◽

Horner's Syndrome ◽

Lumbar Epidural Anesthesia ◽

Brachial Plexus Blockade ◽

Spinal Epidural

Abstract Horner’s Syndrome (HS) with brachial plexus involvement following lumbar epidural anesthesia may be a startling event for the patient and providers. We present a case of Horner’s Syndrome and complete brachial plexus blockade following epidural bolus of lidocaine for labor analgesia that was initially misdiagnosed as a cerebrovascular accident. Use of the catheter was discontinued and the episode resolved with expectant management. This complication is otherwise benign and resolves without sequelae.

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The place of dural puncture epidural as a modern method of pain relief in labor

EMERGENCY MEDICINE ◽

10.22141/2224-0586.17.2.2021.230660 ◽

2021 ◽

Vol 17 (2) ◽

pp. 112-115

Author(s):

A.O. Zhezher ◽

Ye.M. Sulimenko ◽

O.A. Loskutov

Keyword(s):

Side Effects ◽

Epidural Analgesia ◽

Dural Puncture ◽

Epidural Block ◽

Needle Size ◽

Combined Spinal Epidural ◽

Dural Puncture Epidural ◽

Spinal Epidural ◽

The Impact

Childbirth is a physiological process that is accompanied by severe pain. Physiological and psychological factors may be involved in the pathological process. Increasing the concentration of catecholamines may help reduce uteroplacental perfusion. Pain during childbirth can lead to hyperventilation of the mother, which in turn can affect the acid-base status of the fetus and the state of the newborn. Prolonged pain can lead to the development of severe psychological disorders with a violation of the connection between mother and newborn. Acute pain during childbirth can transform into chronic in the postpartum period. The most effective are neuroaxial methods of analgesia: epidural analgesia, combined spinal-epidural analgesia and their modifications. Classical epidural analgesia has minimal adverse and side effects, but may be associated with a high incidence of insufficient analgesia. The frequency of inadequate epidural block reaches 23 %. Combined spinal-epidural analgesia, in contrast to epidural analgesia, has a higher quality of sensory block, but it is associated with a higher frequency of side effects such as hypotension, severe motor block, fetal arrhythmia. Since 2005, dural puncture epidural has been introduced into the practice of obstetric anesthesiologists as a method to improve the quality of classical epidural analgesia with minimal side effects of combined spinal-epidural analgesia. Data from existing studies show that dural puncture epidural potentially improves the quality of analgesia (faster onset of analgesia, better sacral coverage, lower incidence of inadequate block) compared with epidural analgesia and causes less hypotension, disorders of fetal heart rate compared with combined spinal-epidural analgesia. But the spinal needle size is important in achieving these effects. Further researches may be aimed at determining the duration of labor, the option of delivery and the possible impact of dural puncture epidural on the vegetative regulation of labor and a broader study of the impact of this method on the fetus and newborn.

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Pneumocephalus and Seizure in Patient after Epidural Lumbar Puncture: Case Report

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v6i3.3998 ◽

2020 ◽

Author(s):

Arash Azhideh ◽

Farzad Ashrafi ◽

Davood Ommi ◽

Maryam Yousefi-Asl ◽

Mehran Arab-Ahmadi

Keyword(s):

Ct Scan ◽

Epidural Catheter ◽

Dural Puncture ◽

Rare Complication ◽

Epidural Block ◽

Loss Of Consciousness ◽

Regional Analgesia ◽

Lumbar Epidural Analgesia ◽

Loss Of Resistance ◽

Accidental Dural Puncture

Lumbar epidural analgesia is using widely as an alternative method for anesthesia. Although it has its benefits such as the low risk of complications in contrast with general anesthesia, also it has some adverse effects, for instance: headache, loss of consciousness, pneumocephalus, dizziness, and seizure. Pneumocephalus is a rare complication of lumbar epidural block. In this case of study, a patient represents stenosis in the site of anastomosis of colon and duodenum candidate for a repair surgery with the lumbar epidural block. Epidural catheter insertion was done in the sitting position; local anesthesia was administered at the 4th and 5th lumbar vertebral interspace. A 17-gauge Husted needle was inserted using the loss-of resistance (LOR) by air technique. Immediately the patient complained of headaches and then deteriorated to a tonic-clonic movement accompanied by post-seizure sleep, which ended up in termination of the procedure. The first-day CT-scan revealed multiple pneumocephalus. Supporting treatment was administered for 10 days; another CT-scan taken from the patient demonstrated improvement and the patient was discharged without any neurological deficit. Regional analgesia should be administered if possible under the superintendence of an expert, however, complications of an epidural catheter, such as accidental dural puncture, can postpone the recovery of the patient.

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Pneumocephalus Following Unidentified Dural Puncture: A Case Report with an Unusual Neurological Presentation

January 2018 - Pain Physician ◽

10.36076/ppj.2017.e334 ◽

2017 ◽

Vol 2 (20;2) ◽

pp. E329-E334 ◽

Cited By ~ 2

Author(s):

Helena Dutra Figueira

Keyword(s):

Computed Tomography ◽

Chronic Pain ◽

Case Report ◽

Left Ventricle ◽

Epidural Catheter ◽

Subarachnoid Space ◽

Dural Puncture ◽

Cranial Computed Tomography ◽

Common Symptom ◽

Loss Of Resistance

Pneumocephalus is a rare consequence of epidural anesthesia, which may occur following inadvertent or unidentified dural puncture when the loss of resistance to air technique is applied to identify the epidural space. Headache is the most common symptom presented in this condition, usually with sudden onset. This case report describes an unusual presentation of diffuse pneumocephalus after an unidentified dural puncture. The patient (male, 67 years old) was submitted to epidural catheter placement for the treatment of acute exacerbation of ischemic chronic pain using loss of resistance to air technique. No cerebrospinal fluid or blood flashback was observed after needle withdrawal. Shortly after the intervention, the patient presented symptoms of lethargy, apathy, and hypophonia, which are not commonly associated with pneumocephalus. No motor or sensory deficits were detected. Cranial computed tomography showed air in the frontal horn of the left ventricle, subarachnoid space at interhemispheric fissure and basal cisterns, confirming the diagnosis of diffuse pneumocephalus. The patient remained under vigilance with oxygen therapy and the epidural catheter left in place. After 24 hours, cranial computed tomography showed air in the temporal and frontal horns of the left ventricle, with no air in the subarachnoid space. The patient presented no neurological signs or symptoms at this time. Although headache is the most common symptom presented in reported cases of pneumocephalus, this case shows the need for the clinician to be aware of other signs and symptoms that may be indicative of this condition, in order to properly diagnose and treat these patients. Key words: Pneumocephalus, continuous epidural analgesia, ischemic chronic pain, lossof-resistance to air technique, dural puncture, headache, unusual presentation

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Delirium associated with sertraline, a case report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2316 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S619-S619 ◽

Cited By ~ 1

Author(s):

N. Salgado ◽

S. Benavente ◽

B. Macias ◽

M. Duran ◽

P. Leganes

Keyword(s):

Case Report ◽

Side Effects ◽

Attention Deficit ◽

Loss Of Consciousness ◽

Visual Hallucinations ◽

Short Stay ◽

Altered Consciousness ◽

Competing Interest ◽

Antidepressive Medication ◽

Antidepressive Treatment

IntroductionDelirium is a clinical entity consisting of acute loss of consciousness, with attention deficit and fluctuating evolution. Antidepressive medication can cause these symptoms or worsen them.Case reportWe report the case of a 84-year-old blind female who was diagnosed of delirium in relation to intoxication with sertraline. The patient was admitted into a short-stay psychiatric unit for three days. She presented behavioural disturbances consisting in auto and heteroaggressive behaviour, altered consciousness and visual hallucinations (rocks, turtles). When dosage of sertraline was doubled from 50 mg/day to 100 mg/day visual hallucinations started. There were not other medical causes found, so sertraline was suspended, achieving clinical improvement.DiscussionThis case report shows how a patient with antidepressive treatment can display delirium. The three main causes of delirium that are infections, side effects and methabolic syndrome.ConclusionsIn the case of treating a patient with delirium, the presence of previous illness has to be investigated. It is indispensable to describe the presence of previous illness, medication and recent changes of the dosages in the medical history in a patient with Sertraline.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Myoclonus-like involuntary movements under subarachnoid block completely subsided after midazolam administration in a patient undergoing cesarean section: a case report

10.7287/peerj.preprints.101v1 ◽

2013 ◽

Author(s):

Kiichi Hirota

Keyword(s):

Case Report ◽

Side Effects ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Epidural Anesthesia ◽

Involuntary Movement ◽

Upper Extremities ◽

Spontaneous Pain ◽

Subarachnoid Block ◽

Involuntary Movements

Involuntary movement during and after neuraxial anesthesia, such as spinal and epidural anesthesia, is rarely observed. In this report, we describe a case of myoclonus-like involuntary movement of the upper extremities in a patient undergoing a planned repeat cesarean section under spinal anesthesia with bupivacaine that completely subsided after 2mg midazolam administration. The myoclonus-like movement never recurred or caused any apparent neurological side effects. No abnormal sensation or spontaneous pain of the upper extremities was observed. The patient was discharged on foot on post-operative day 3.

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