Abstract

Case Report

Pneumocephalus following labour epidural analgesia, a rare case report

Shagufta Rafiq*, Ibrahim Abbasher, Sadia Anwar, Ammara Ahmad, Bushra Aziz and Branko Denona

Published: 05 May, 2021 | Volume 4 - Issue 2 | Pages: 066-068

The lumbar epidural analgesia is commonly used for labour analgesia. The “loss of resistance to air” LORA technique is commonly used for recognition of epidural space. One of the rare complications of this technique is Pneumocephalus (PC). We want to present a case of Pneumocephalus which the mother developed during epidural analgesia in labour. The patient complained of severe headache immediately after attempt at epidural catheter insertion. The symptoms progressively worsened following delivery. A postnatal anaesthetic review was performed and an urgent CT scan of the brain was arranged that showed pneumocephalus. A conservative management pathway was followed with liberal analgesia, oxygen inhalation and keeping the patient mostly in supine position. Her symptoms regressed in severity over the next three days and subsided after one week. We believe that the amount of air used for LORA should be minimized; LORA should not be used after dural puncture and the use of normal saline would alleviate the risk.

Read Full Article HTML DOI: 10.29328/journal.cjog.1001089 Cite this Article Read Full Article PDF

References

  1. Reasoner DK, Todd MM, Scamman FL, Warner DA. The incidence of pneumocephalus after supratentorial craniotomy. Observations on the disappearance of intracranial air. Anesthesiology. 1994; 80: 1008-1012. PubMed: https://pubmed.ncbi.nlm.nih.gov/8017640/
  2. Peterson HO, Kieffer SA. Neuroradiology. New York, Hayon and Row. 1984; 1: 127-130. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050972/
  3. Heinz ER. Techniques in imagimg of the spine, part 3: Myelography, The Clinical Neurosciences: Neuroradiology. Edited by Rosenberg RN. New York, Churchill Livingstone. 1984; 795-817.
  4. Finch MD, Morgan GA. Traumatic pneumocephalus following head injury. A complication of general anaesthesia. Aneasthesia. 1991; 46: 385-387. PubMed: https://pubmed.ncbi.nlm.nih.gov/2035788/
  5. Candan S, Katelioglu M, Ceylan S, Köksal I. Otogenic brain abcess with pneumocephalus. Infection. 1990; 18: 191-192. PubMed: https://pubmed.ncbi.nlm.nih.gov/2365472/
  6. Finelli P, Bergan R. Spontaneous pneumocephalus with meningitis: CT demonstration. J Comput Assist Tomogr. 1991; 15: 525-526. PubMed: https://pubmed.ncbi.nlm.nih.gov/2026827/
  7. Ozturk E, Kantarci M, Karaman K, Basekim CC, Kizilkaya E. Diffuse pneumocephalus associated with infratentorial and supratentorial haemorrhages as a complication of spinal surgery. Acta Radiol. 2006: 47: 497-500. PubMed: https://pubmed.ncbi.nlm.nih.gov/16796314/
  8. Yoon SJ, Oh GS, Lee SJ, Lee BR, Chun J, et al. Pneumocephalus in patients with orthostatic headache. J Clin Neurol. 2008; 4: 89-93. PubMed: https://pubmed.ncbi.nlm.nih.gov/19513309/
  9. Hawley JS, Ney JP, Swanberg MM. Subarachnoid peumocephalus from epidural steroid injection. Headache. 2005; 45: 247-248. PubMed: https://pubmed.ncbi.nlm.nih.gov/15836602/
  10. Simopolulos T, Peeters-Asdourian C. Pneumocephalus after cervical epidural steroid injection. Anesth Analg. 2001; 92: 1576-1577. PubMed: https://pubmed.ncbi.nlm.nih.gov/11375849/
  11. Han CS, Yu JS, Kim IH, Kim YJ, Kim CS, et al. Headache and pneumocephalus after lumbar epidural block: A case report. J Korean Pain Soc. 1996; 9: 251-255.
  12. Spence D, Nations R, Rivera O, Bowdoin S, Hazen B, et al. Evidence-based anesthesia: The use of preprocedural ultrasonography during labor to facilitate placement of an epidural catheter. AANA J. 2012; 80: 223-230.
  13. Avellanal M, Olmedilla L, Ojea R, Rueda ML, Navia J. Pneumocephalus after spinal anesthesia. Anesthesiology. 1996; 85: 423-425. PubMed: https://pubmed.ncbi.nlm.nih.gov/8712460/
  14. Reynolds F, Speedy HM. The subdural space: the third place to go astray. Anaesthesia. 1990; 45: 120-123. PubMed: https://pubmed.ncbi.nlm.nih.gov/2181886/
  15. Kim YJ, Baik HJ, Kim JH, Jun JH. Pneumocephalus developed during epidural anesthesia for combined spinal-epidural anesthesia. Korean J Pain. 2009; 22: 163-166.
  16. Ahlering JR, Brodsky JB. Headache immediately following attempted epidural analgesia in obstetrics. Anesthesiology. 1980; 52: 100-101. PubMed: https://pubmed.ncbi.nlm.nih.gov/7352636/
  17. Katz JA, Lukin R, Bridenbaugh PO, Gunzenhauser L. Subdural intracranial air: an unusual cause of headache afterepidural steroid injection. Anesthesiology. 1991; 74: 615-618. PubMed: https://pubmed.ncbi.nlm.nih.gov/1825771/
  18. Nafiu OO, Urquhart JC. Pneumocephalus with headache complicating labour analgesia: should we still be using air?  Int J Obstet Anesth. 2006; 15: 237-239. PubMed: https://pubmed.ncbi.nlm.nih.gov/16798452/
  19. Gomez-Rios MA, Fernandez-Goti MC. Pneumocephalus after inadvertent dural puncture during epidural anesthesia; Anesthesiology. 2013; 118: 444. PubMed: https://pubmed.ncbi.nlm.nih.gov/22692380/

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