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Ascending back pain and headache during attempted epidural placement
J M Kreitzer1, A P Reed, A T Dauro
1Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY.
Journal of Clinical Anesthesia
|September 1, 1991
Summary
A rare complication of epidural analgesia occurred when air entered the brain. This resulted in severe headache due to intracranial air after a difficult epidural placement.
Area of Science:
- Neurology
- Anesthesiology
- Radiology
Background:
- Epidural analgesia is a common pain management technique during labor.
- The loss-of-resistance-to-air technique is frequently used to identify the epidural space.
Observation:
- A parturient experienced severe back and neck pain immediately after epidural placement.
- Symptoms rapidly progressed to a severe, unrelenting headache.
Findings:
- A computerized tomographic (CT) scan revealed air within the intracranial subarachnoid space.
- This finding suggests intrathecal or intraventricular air introduced during the epidural procedure.
Implications:
- Accidental intrathecal or intraventricular air can cause significant neurological symptoms, including severe headache.
- Careful technique and confirmation of epidural space entry are crucial to prevent complications.
- Further investigation into the precise mechanism of air migration is warranted.