Cerebrospinal fluid cutaneous fistula after neuraxial anesthesia: an effective treatment approach

Cerebrospinal fluid cutaneous fistula is a rare but potentially serious complication of epidural analgesia. We report the case of a patient submitted to total knee arthroplasty under subarachnoid block and placement of lumbar epidural catheter for post-operative analgesia. The epidural catheter was found exteriorised on the fourth post-operative day, and the patient presented with a moderate fluid leak from the puncture site that was confirmed to be cerebrospinal fluid by cytological and chemical analysis. The initial therapeutic approach consisted of bed rest, hydration and prophylactic antibiotic therapy for 3 days, but it was ineffective as the leak persisted. A suture was placed at the epidural insertion site with immediate resolution of the leak. The suture was maintained for 5 days. The patient progressed satisfactorily without requiring further therapies.