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Pneumomediastinum: A Rare Complication of Epidural Analgesia

Vibhavari M Naik1, Syed Nusrath2, Basanth K Rayani1

  • 1Department of Anaesthesiology, Surgical Critical Care, Pain and Palliative Medicine, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, IND.

Cureus
|November 18, 2021
PubMed

Insights

Pneumomediastinum is a rare complication of epidural blocks. This case highlights an incidental finding of pneumomediastinum two days post-procedure, a previously unreported occurrence.

Area of Science:

  • Anesthesiology
  • Radiology
  • Thoracic Surgery

Background:

  • Epidural blocks are common procedures, but rare complications can occur.
  • Pneumomediastinum, the presence of air in the mediastinum, is a potentially life-threatening condition.
  • The loss of resistance (LOR) technique with air is a method used for epidural placement.

Observation:

  • This report details a rare case of pneumomediastinum following an epidural block.
  • The pneumomediastinum was incidentally discovered two days after the epidural procedure.
  • This delayed, incidental finding has not been previously documented in medical literature.

Findings:

  • Pneumomediastinum following epidural block, particularly with the air-insufflation LOR technique, is exceptionally rare.
  • The proposed mechanism involves air tracking from the epidural space into the posterior mediastinum via intervertebral foramina and fascial planes.
  • This case represents the first reported instance of pneumomediastinum being an incidental finding days after the epidural procedure.

Implications:

  • Clinicians should consider epidural block as a potential cause of pneumomediastinum, especially in the postoperative period.
  • Radiologists and clinicians interpreting imaging studies should be aware of this rare complication.
  • Prompt recognition and consideration of epidural block are crucial for managing this serious condition.
Keywords:
complicationepidural blockloss of resistance techniquepneumomediastinumpneumorrhachispost-operative

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