Accidental intradural injection during attempted epidural block -A case report-

Abstract

Several cases of accidental subdural injection have been reported, but only few of them are known to be accidental intradural injection during epidural block. Therefore we would like to report our experience of accidental intradural injection. A 68-year-old female was referred to our pain clinic due to severe metastatic spinal pain. We performed a diagnostic epidural injection at T9/10 interspace under the C-arm guided X-ray view. Unlike the usual process of block, onset was delayed and sensory dermatomes were irregular range. We found out a dense collection of localized radio-opaque contrast media on the reviewed X-ray findings. These are characteristic of intradural injection and clearly different from the narrow wispy bands of contrast in the subdural space.

Unintended subdural anesthesia and subdural air bubbles after attempted epidural anesthesia in a patient undergoing cesarean section

“…However, it is important to note that epidural anesthesia rarely leads to unintended subdural injections, as evidenced by the reported case [1][2][3]. Subdural spaces seem to be creat- ed by traumatic meningeal dissection between the dural and arachnoid layers, rather than a fixed potential space [9].…”

“…Therefore, diagnosis can be delayed and sometimes entirely missed. Understanding subdural anesthesia is important because extensive blockade can spread to the cervical or cranial nerves, leading to significant cardiovascular depression due to an impaired sympathetic nervous system [ 1 - 3 ]. When performing the loss-of-resistance technique for epidural anesthesia, the use of air has the advantage of facilitating the detection of dural puncture [ 4 , 5 ].…”

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Several cases of unintended subdural anesthesia during attempted epidural anesthesia have been reported [1][2][3]. Subdural anesthesia is not rare, but is often poorly recognized because of confusion and various features of neuraxial blockade.

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Inyección subdural: informe de dos casos

“…Se acepta que existe este tipo de bloqueo ante la presencia de los dos criterios mayores y al menos uno menor (5,(23)(24)(25)(26). Nuestro primer paciente tuvo los dos criterios mayores y más de uno menor, lo que nos orientó hacia dicho diagnóstico.…”

Intrauterine fetal bradycardia after accidental administration of the anesthetic agent in the subdural space during epidural labor analgesia -A case report-

“…Administration of a test dose, i.e., a small amount of a local anesthetic and epinephrine mixture, aids in accurate location of the epidural space. If possible, the epidural anesthetic agent should be administered under guidance such as, that of C-arm imaging [3]. However, the results of many studies have indicated that subdural injection is a negative finding as in the current case [4].…”