Failed spinal anesthesia due to accidental dural puncture: a case report.

Area of Science:

• Anesthesiology
• Obstetrics
• Neurosurgery

Background:

• Presents a case of inadequate spinal anesthesia in a pregnant patient undergoing cesarean section.
• The inadequacy is suspected to be caused by cerebrospinal fluid (CSF) leakage into the epidural space following an accidental dural puncture (ADP).

Purpose of the Study:

• To highlight the potential complication of reduced spinal anesthesia efficacy due to CSF leakage after ADP in pregnant patients.
• To emphasize the importance of considering CSF leakage when spinal anesthesia levels do not meet expectations.

Main Methods:

• A 28-year-old pregnant woman with twin pregnancy was scheduled for combined spinal-epidural anesthesia (CSEA) for cesarean section.
• Repeated accidental dural punctures occurred at T12/L1 before spinal anesthesia administration at L3/4.
• Spinal anesthesia with hyperbaric bupivacaine and fentanyl was administered, but resulted in an inadequate analgesia level up to T12.

Main Results:

• The spinal anesthesia provided insufficient analgesia, reaching only the T12 dermatome.
• It is hypothesized that significant leakage of local anesthetic into the epidural space via the injured dura compromised the spinal block.
• The planned surgery was successfully completed under general anesthesia.

Conclusions:

• In pregnant women undergoing spinal anesthesia after an accidental dural puncture, significant CSF leakage can impede the expected increase in anesthesia level.
• Anesthesiologists should be vigilant for potential complications arising from dural breaches during neuraxial procedures in obstetric patients.