Challenges with labour epidural placement in a parturient with a lumbar arachnoid cyst: a case report

This case report describes the management of a patient with a lumbar arachnoid cyst requesting epidural labour analgesia. The patient was otherwise healthy but had suffered from multiple dural punctures during attempted epidural placement in a previous pregnancy. Magnetic resonance imaging following the dural punctures revealed the cyst, which was at the level of the L3-4 interspace, effacing the posterior epidural space at that level. Multidisciplinary management in this subsequent pregnancy, involving radiology and anaesthesia specialists, allowed ultrasound-guided identification of a higher epidural space, and successful and uneventful epidural placement during labour. Multiple dural punctures with attempted epidural placement should prompt anaesthetists to consider spinal magnetic resonance imaging to identify anatomical abnormalities that may be present, which may have implications for future management.