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The subdural space: the third place to go astray.
1Anaesthetic Department, St. Thomas' Hospital, London.
Anaesthesia
|February 1, 1990
Summary
Subdural placement of epidural needles or catheters can cause unexpected complications, including headaches and neurological issues. This occurs because the needle or catheter tip is not in the epidural space but the subdural space.
Area of Science:
- Anesthesiology
- Neurosurgery
- Neurology
Background:
- Epidural blockade is a common anesthetic technique.
- Unexpected complications can arise during epidural procedures.
- Accurate needle and catheter placement is crucial for efficacy and safety.
Observation:
- Subdural placement of the Tuohy needle or epidural catheter tip is a potential cause of complications.
- This misplacement can lead to 'unexplained' headaches.
- It may also result in false-negative aspiration and test dose results.
Findings:
- Subdural placement can cause unilateral block.
- Delayed total spinal anesthesia and neurological sequelae are associated with this misplacement.
- Profound blocks of delayed onset are characteristic of subdural blockade.
Implications:
- Recognizing subdural placement is key to managing unexpected epidural complications.
- This understanding can improve patient safety and outcomes.
- Further investigation into diagnostic methods for subdural placement is warranted.