Case Report: Pneumocephalus after labor epidural anesthesia

Abstract

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.

Pneumocephalus Following Combined Spinal Epidural Anaesthesia for Total Knee Arthroplasty: A Case Report

“…Nistal and Gomez postulated mechanism of pneumocephalus as being due to dural puncture when a catheter goes into the subarachnoid space after its initial subdural placement and movement to the arachnoid and the first puncture in the dura yields migration of catheter 5 . Air introduced into subdural space is more painful than in subarachnoid space and reaches the head rapidly due to low pressure and diminished capacitance 4 .…”

“…Nistal and Gomez suggested minimization in the amount of air used in identification of epidural space in LORA technique to lower risk of pneumocephalus. Saline instead of air had been recommended alternatively to avoid pneumocephalus 5 .…”

“…This case report offers guidance and raises awareness of the incidence and management of pneumocephalus. The use of saline instead of air should be considered in epidural anaesthesia to minimise incidence of pneumocephalus 5 .…”

“…Lumbar epidural anaesthesia is a common technique used during lower limb surgery. Loss of resistance to air (LORA) technique is widely used for identification of epidural space with several complications reported such as pneumocephalus 1 , 2 , subcutaneous emphysema 3 , venous air embolism 4 , and spinal cord and nerve root compression 5 . We report an unusual case of pneumocephalus following epidural anaesthesia in a patient who underwent total knee arthroplasty.…”

Pneumocephalus After Dural Puncture During Epidural Analgesia: A Case Report

“…2 The occurrence of air density areas within the cranial cavity on the computed tomography scan, which is more sensitive than magnetic resonance imaging, approve the diagnosis. 3…”