SUBDURAL BLOCK – A COMPLICATION OF EPIDURAL ANAESTHESIA A CASE REPORT
Abstract
Background. Epidural anaesthesia (EA) is a regional anaesthesia method that interrupts afferent nerve conduction. Epidural space (ES) is a space between internal leaf of a dura mater and spinal periosteum. The complications of regional anaesthesia are rare and are less common than those of general anaesthesia. The incidence of permanent neurological deficit is 0.03–0.1%. Subdural injection is a complication of epidural anaesthesia with an incidence of 0.82%.
Subdural space is difficult to enter deliberately as arachnoidea is closely adherent to the overlying dura in most patients. Injection of the local anaesthetic solution into this space produces a high level of sensory and motor anaesthesia.
Patients and methods. A case of 47-year-old female operated for cancer of the rectosigma is described. According to the kind of operation, a combined general and epidural anaesthesia was used. Despite proper insertion of a epidural catheter and recommended tests of its incorrect placement, the total spinal block developed. It is believed that a rare complication in the form of so-called subdural block occurred.
Conclusions. Combined general and epidural anaesthesia is becoming widespread for major surgery and it is commonly used in developed countries. The purpose of this study was to warn on relatively rare complication of epidural anaesthesia. Only careful attention and a high index of suspicion for the development of the signs of subdural block will prevent complications.
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References
Pevec-Gašperin M. Epiduralna anestezija. In: Paver-Eržen V. Podiplomsko izobraževanje iz anesteziologije, peti tečaj, 4.–6. 4. 1997, Portorož. Ljubljana: Slovensko zdravniško društvo, Sekcija za anesteziologijo in intenzivno medicino, 1997: 277–95.
Raj P, Nolte H, Stanton-Hicks M. Illustrated manual of regional anaesthesia. Berlin, Heidelberg: Springer-Verlag, 1988: 32–3.
Kobe V, Dekleva A, Lenart IF, Širca A, Velepič M. Ovojnice centralnega živčevja. In: Anatomija. Skripta za študente medicine, 2. del. Ljubljana: Medicinska fakulteta, 1990: 34–5.
Orbegozo M, Sheikh T, Slogoff S. Subdural cannulation and local anesthetic injection as a complication of an intended epidural anesthetic. J Clin Anesth 1999; 11: 129–31.
Blomberg RG. The lumbal subdural extraarachnoid space of humans: An anatomical study using spinaloscopy in autopsy cases. Anesth Analg 1987; 66: 177–80.
Lubenow T, Keh-Wong E, Kristof K, Ivankovich O, Ivankovich AD. Inadvertent subdural injection: A complication of an epidural block. Anesth Analg 1988; 67: 175–9.
Wedel DJ. Neurological complications of spinal and epidural anaesthesia. In: Van Zaundert A. Highlights in pain therapy and regional anaesthesia VI. XVI Annual ESRA Congress. London: Permanyer Publications, 1997: 21–30.
Mušič ŠE, Denič K, Hollan J. Zapleti pri izvajanju epiduralne blokade. Seminar na sestanku zdravnikov Kliničnega oddelka za anesteziologijo in intenzivno terapijo operativnih strok Kliničnega centra Ljubljana. Ljubljana; Klinični center, 2001.
Larsen R. Periduralanaesthesie. In: Larsen R. Larsen Anaesthesie. 6th ed. Muenchen, Wien, Baltimore: Urban und Schwarzenberg, 1999: 555–7.
Mulroy MF, Norris MC, Liu SS. Safety steps for epidural injection of local anesthetics: Review of the literature and recommendations. Anesth Analg 1997; 85: 1346–56.
Liu A, Dodd KW. Accidental subdural catheterisation. Anaesthesia 1986; 41: 847–9.
Chauhan S, Gaur A, Tripathi M, Kaushik S. Unintentional combined epidural and subdural block, Case report. Reg Anesth 1995; 20 (3): 249–51.
Švajger M. Anestezija za velike abdominalne operacije. In: Paver-Eržen V. Podiplomsko izobraževanje iz anesteziologije, četrti tečaj, 29.–31. 3. 1996, Portorož. Ljubljana: Slovensko zdravniško društvo, Sekcija za anesteziologijo in intenzivno medicino, 1996: 321–2.
Lehmann LJ, Pallares VS. Subdural injection of local anesthetic with steroids: Complication of epidural anesthesia. South Med J 1995; 88 (4): 467–9.
Mehta M, Maher R. Injection into the extra-arachnoid subdural space. Anesthesia 1977; 32: 177–80.
Mitterschiffthaler G. The multicompartment block. Acta Anaesthesiol Scand 1997; 41: Suppl 111: 105–6.
Palkar NV, Boudreaux RC, Mankad AV. Accidental total spinal block: a complication of an epidural test dose. Can Anaesth Soc J 1992; 39: 1058– 60.
Reynolds F, Speedy HM. The subdural space: the third place to go astray. Anesthesia 1992; 45: 120–3.
Hatrick CT, Pither CE, Umeshraya P. Subdural migration of an epidural catheter. Anesth Analg 1985; 64: 175–8.
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