Abstract
We describe a case in which severe lower extremity radicular pain occurred after administration
of 0.9% saline into the subarachnoid space through a catheter that had been left for
20 h following inadvertent dural puncture in an obstetric patient. A 42-year-old (G8P7)
woman was admitted for repeat cesarean delivery. Accidental dural puncture occurred
during epidural placement. Following a slow 10-mL intrathecal injection of 0.9% normal
saline an epidural catheter was advanced into the subarachnoid space. Spinal anesthesia
was used for cesarean delivery and the subarachnoid catheter was kept in place for
20 h. Before catheter removal, an additional 10 mL of 0.9% saline was slowly administered into the intrathecal space. Almost instantly,
the patient complained of back pain that progressed to lower extremity radicular pain
and paresthesia; symptoms began to resolve after 10 min. Subsequently, the patient developed a postdural puncture headache that persisted
for three days. The patient’s radiculitis and paresthesia likely resulted from an
acute increase in intrathecal pressure after saline administration or from direct
catheter irritation. Although both intrathecal saline administration and subarachnoid
catheter placement have been previously proposed as ways to prevent postdural puncture
headache, their efficacy remains controversial, and we advise caution with these techniques.
Keywords
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References
- PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies.Can J Anesth. 2003; 50: 460-469
- Post-dural puncture headache in the obstetric patient: an old problem. New solutions.Minerva Anestesiol. 2004; 70: 823-830
- Prevention of postdural puncture headache after accidental dural puncture: a quantitative systematic review.Br J Anaesth. 2010; 105: 255-263
- Posture and fluids for preventing post-dural puncture headache.Cochrane Database Syst Rev. 2002; : CD001790
- North American survey of the management of dural puncture occurring during labour epidural analgesia.Can J Anaesth. 1998; 45: 110-114
- Epidural blood patching for preventing and treating post-dural puncture headache.Cochrane Database Syst Rev. 2010; : CD001791
- Efficacy of a prophylactic epidural blood patch in preventing post dural puncture headache in parturients after inadvertent dural puncture.Anesthesiology. 2004; 101: 1422-1427
- Post-dural puncture headache: pathogenesis, prevention and treatment.Br J Anaesth. 2003; 91: 718-729
- Fluid flow through dural puncture sites. An in vitro comparison of needle point types.Anaesthesia. 1989; 44: 415-418
- MRI findings in lumbar puncture headache syndrome: abnormal dural-meningeal and dural venous sinus enhancement.Clin Imag. 1999; 23: 73-76
- The injection of intrathecal normal saline reduces the severity of postdural puncture headache.Reg Anesth Pain Med. 2001; 26: 301-305
- Studies of the pharmacology and pathology of intrathecally administered 4-anilinopiperidine analogues and morphine in the rat and cat.Anesthesiology. 1986; 64: 54-66
- Subarachnoid catheter placement after wet tap for analgesia in labor: influence on the risk of headache in obstetric patients.Reg Anesth Pain Med. 2003; 28: 512-515
- Effect of intrathecal saline injection and Valsalva maneuver on cerebral perfusion pressure during transsphenoidal surgery for pituitary macroadenoma.J Neurosurg Anesthesiol. 1995; 7: 1-6
- The intrinsic vasculature of the lumbosacral spinal nerve roots.Spine (Phila Pa 1976). 1985; 10: 508-515
- Physiologic changes of nerve root during posterior lumbar discectomy.Spine (Phila Pa 1976). 1995; 20: 654-659
Article info
Publication history
Published online: June 02, 2011
Accepted:
March 5,
2011
Identification
Copyright
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
