Cerebrospinal fluid fistula after combined spinal-epidural block

Abstract

Neuraxial anaesthesia is an essential technique in obstetric anaesthesia practice. Cerebrospinal fluid (CSF) fistula is a rare complication and there is no consensus about its clinical approach. We present a case of a 28-year-old nulliparous woman that developed a cutaneous CSF fistula following combined spinal and epidural block for caesarean delivery. After multidisciplinary discussion it was decided that hydration, absolute bed-rest and compressive dressing with abdominal binder was the best option and the patient fully recovered without any sequelae.Based on literature, symptoms of intracranial hypotension and leakage of clear fluid surrounding the puncture site usually motivate referral to anaesthesia. Management strategies can be both conservative and invasive, including direct suture of the skin puncture site and epidural blood patch.Regarding the anaesthesia practice on this topic, most of the available evidence is based on case reports, rendering the decision-making process challenging.

Pilonidal disease in the pregnant patient: A case report

“…Labor analgesia is most commonly managed with a lumbar epidural [ 11 ]. Epidural abscess, meningitis and cerebrospinal fluid fistula are infrequent complications of epidural anesthesia but have been reported in the literature [ 11 , 12 ]. It is unknown whether the proximity of a chronic wound from pilonidal disease to the site of epidural placement would increase the risk of these rare complications, but the proximity could potentially be a risk factor for infection of the epidural space.…”

Cerebrospinal Fluid Cutaneous Fistula Following Neuraxial Anesthesia for Cesarean Delivery

“…Neuraxial techniques are considered the gold standard in obstetric anesthesia, for both labor analgesia and as an anesthetic technique for cesarean delivery [ 1 ]. The combined spinal-epidural (CSE) technique is often employed, as it enables a rapid onset of anesthesia with the possibility to maintain both analgesia and anesthesia through the catheter [ 2 ].…”