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

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.

scholarly journals Pneumocephalus following fluoroscopy-guided lumbar epidural injection in elderly patients: two cases report and a review of Korean literatures - Two cases report -

2020 ◽  
Vol 15 (4) ◽  
pp. 492-497
Author(s):  
Sun Kyung Park ◽  
Sang Hyun Park ◽  
Bang Won Lee ◽  
Woo Jin Cho ◽  
Yun Suk Choi
Keyword(s):  
Elderly Patients ◽  
Pain Control ◽  
Older Patients ◽  
Dural Puncture ◽  
Epidural Injection ◽  
Epidural Block ◽  
Contrast Injection ◽  
Anatomical Changes ◽  
Loss Of Resistance ◽  
Accidental Dural Puncture

Background: Pneumocephalus can originate from accidental dural puncture while performing epidural block using the loss-of-resistance (LOR) technique with an air-filled syringe. Case: We present two cases of pneumocephalus after lumbar epidural block under fluoroscopy for pain control in elderly patients. Conclusions: Lumbar epidural block should be performed under fluoroscopic guidance in elderly patients with severe lesions. The physician should be aware of the increased possibility of a dural puncture occurring due to anatomical changes in older patients. The use of saline is recommended for the LOR technique. A contrast injection should be used together with the LOR technique to locate the epidural space. If a dural puncture occur, the patient should be carefully monitored to determine whether pneumocephalus has developed.

scholarly journals Punção Acidental da Dura e Cefaleia Pós-punção da Dura na População Obstétrica: Oito Anos de Experiência

2016 ◽  
Vol 29 (4) ◽  
pp. 268
Author(s):  
Maria Vaz Antunes ◽  
Adriano Moreira ◽  
Catarina Sampaio ◽  
Aida Faria
Keyword(s):  
Conservative Treatment ◽  
Epidural Catheter ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Spinal Block ◽  
Post Dural Puncture Headache ◽  
Retrospective Audit ◽  
Prophylactic Measures ◽  
Blood Patch ◽  
Accidental Dural Puncture

<p><strong>Introduction:</strong> Accidental dural puncture is an important complication of regional anesthesia and post-dural puncture headache remains a disable outcome in obstetric population. The aim of our study was to calculate the incidence of accidental puncture and post-puncture headache and evaluate its management among obstetric anesthesiologists.<br /><strong>Material and Methods:</strong> We conducted a retrospective audit, between January 2007 and December 2014. We reviewed the record sheets of patients who experienced either accidental puncture or post-puncture headache. We excluded the patients undergoing spinal block. We use the SPSS 22.0 for statistical analyses.<br /><strong>Results:</strong> We obtained 18497 neuro-axial blocks and 58 accidental dural punctures (0.3%). After detected puncture, in 71.4% epidural catheter was re-positioned and 21.4% had intra-thecal catheters. Forty-five (77.6%) developed headache and the prophylactic measures were established in 76.1%. Conservative treatment was performed in all patients. The epidural blood patch was performed in 32.8% with a 84.2% of success.<br /><strong>Discussion:</strong> The incidence of post-dural puncture headache is unrelated to the type of delivery or insertion of intrathecal catheter. The re-placement of the epidural catheter remains the main approach after puncture. The institution of prophylactic measures is a common practice, despite the low level of evidence. We performed epidural blood patch after failure of conservative treatment.<br /><strong>Conclusion:</strong> The incidence of accidental dural puncture and post-dural puncture headache was similar to the literature. Despite being a common complication, there remains lack of consensus on its approach.</p>

scholarly journals Pneumocephalus After Dural Puncture During Epidural Analgesia: A Case Report

2019 ◽  
Vol 7 (1) ◽  
pp. 52-53
Author(s):  
Gholamreza Mohseni ◽  
Faranak Behnaz ◽  
Zahra Tahmasebi
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Epidural Analgesia ◽  
Epidural Anesthesia ◽  
Dural Puncture ◽  
Loss Of Consciousness ◽  
Loss Of Resistance ◽  
Lumbar Epidural Anesthesia ◽  
Post Operation ◽  
Control Post

Lumbar epidural anesthesia commonly used to control post-operation pain. The ‘loss-ofresistance’ to air technique (LORA) generally engaged in the appreciation of the epidural space. One of the rare but serious side effects of this technique is pneumocephalus. We report a case of sudden frontal and parietal headache after a dural puncture during the performance of epidural analgesia using the LOR to air technique. Keywords: Epidural analgesia; ‘loss-of- resistance’ to air technique (LORA); Pneumocephalus; loss of consciousness; headache.

scholarly journals Differentiating False Loss of Resistance from True Loss of Resistance While Performing the Epidural Block with the CompuFlo® Epidural Instrument

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Pasquale Vaira ◽  
Michela Camorcia ◽  
Tiziana Palladino ◽  
Matteo Velardo ◽  
Giorgio Capogna
Keyword(s):  
Epidural Space ◽  
Epidural Block ◽  
Epidural Needle ◽  
Predictive Values ◽  
Specificity And Sensitivity ◽  
Loss Of Resistance ◽  
Accidental Dural Puncture ◽  
Sudden Decrease ◽  
Sensitivity Specificity ◽  
Labor Epidural

Background. The occurrence of false losses of resistance may be one of the reasons for inadequate or failed epidural block. A CompuFlo® epidural instrument has been introduced to measure the pressure of human tissues in real time at the orifice of a needle and has been used as a tool to identify the epidural space. The aim of this study was to investigate the sensitivity and the specificity of the ability of CompuFlo® to differentiate the false loss of resistance from the true loss of resistance encountered during the epidural space identification procedure. Method. We performed epidural block with the CompuFlo® epidural instrument in 120 healthy women who requested labor epidural analgesia. The epidural needle was considered to have reached the epidural space when an increase in pressure (accompanied by an increase in the pitch of the audible tone) was followed by a sudden and sustained drop in pressure for more than 5 seconds accompanied by a sudden decrease in the pitch of the audible tone, resulting in the formation of a low and stable pressure plateau. We evaluate the sensitivity, specificity, and positive and negative predictive values of the ability of CompuFlo® recordings to correctly identify the true LOR from the false LOR. Results. The drop in pressure associated with the epidural space identification was significantly greater than that recorded after the false loss of resistance (73% vs 33%) (P=0.000001). The sensitivity was 0.83, and the AUC was 0.82. Discussion. We have confirmed the ability of CompuFlo® to differentiate the false loss of resistance from the true loss of resistance and established its specificity and sensitivity. Conclusion. An easier identification of dubious losses of resistance during the epidural procedure is essential to reduce the number of epidural attempts and/or needle reinsertions with the potential of a reduced risk of accidental dural puncture especially in difficult cases or when the procedure is performed by trainees.

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

2017 ◽  
Vol 2 (20;2) ◽  
pp. E329-E334 ◽  
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

scholarly journals “Don't Turn the Needle!”

1993 ◽  
Vol 21 (3) ◽  
pp. 328-330 ◽  
Author(s):  
B. L. Duffy
Keyword(s):  
Epidural Catheter ◽  
Epidural Space ◽  
Epidural Anaesthesia ◽  
Dural Puncture ◽  
Epidural Needle ◽  
Accidental Dural Puncture ◽  
Spinal Ligaments

Accidental dural puncture is a well-recognised complication of epidural anaesthesia. The technique of inserting the epidural needle with the bevel parallel to the spinal ligaments is still taught in some centres. Evidence is presented that the subsequent turning of the needle to allow passage of the epidural catheter may increase the likelihood of dural puncture. There would also appear to be a greater chance of subdural catheterisation. The epidural needle should be introduced with the bevel in the direction in which the catheter is to go and not moved once the epidural space is located.

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