Complication Of Dural Puncture Research Articles

Postpartum seizure as a complication of dural puncture and intracranial hypotension.

Postpartum seizure as a complication of dural puncture and intracranial hypotension.

Intracranial subdural hematoma: a rare but serious complication following neuraxial anesthesia in obstetric anesthesia

Intracranial subdural hematoma (SDH) formation is an uncommon but serious complication of planned or unintentional dural puncture (DP) during straight epidural anesthesia, combined spinal-epidural, dural puncture epidural, or spinal anesthesia. Diagnosis of intracranial SDH following neuraxial anesthesia may be delayed or misdiagnosed due to rare occurrence, lack of knowledge, as well as an overlap in clinical presentation with postdural puncture headache (PDPH). Increased awareness of intracranial SDH as a complication of DP may result in earlier recognition and prevention of potentially devastating outcomes. This article reviews the relevant literature on association of neuraxial anesthesia with intracranial SDH formation.
 Key words: Intracranial subdural hematoma; Anesthesia, Neuraxial; Anesthesia, Epidural; Combined spinal-epidural; Dural puncture; Anesthesia, spinal; Pregnancy; Postdural puncture headache
 Citation: Dhoon TQ, Joshi J, Portnoy D, Rajan GC. Intracranial subdural hematoma: a rare but serious complication following neuraxial anesthesia in obstetric anesthesia. Anaesth. pain intensive care 2021;25(6):828-831:
 DOI: 10.35975/apic.v25i6.1719
 Received: August 4, 2021, Reviewed: September 2, 2021, Accepted: October 3, 2021

P.132 Subdural haematoma formation: a rare complication of dural puncture during epidural insertion

P.132 Subdural haematoma formation: a rare complication of dural puncture during epidural insertion

Comparison of 25 Gauge Cutting with Noncutting Needles for Post Dural Puncture Headache in Obstetric Patients

Introduction: Post dural puncture headache (PDPH) is the most common complication of dural puncture, occurring in up to 36.5% of spinal taps. Clinical and laboratory research have shown that use of small gauge needles particularly of the pencil point design is associated with lower incidence of PDPH then traditional cutting needles. Objective: To compare the frequency and severity of postdural puncture headache between 25G cutting and non cutting needles used for subarachnoid block in patients undergoing cesarean section. Study design: Randomized clinical trial Place and duration of study: Department of anesthesiology, Dow university of Health Sciences, Karachi, Pakistan, during January 10, 2008 to July 9, 2008 Subject and methods: Sixty consecutive under the age of 35 years with class ASA I and II women were enrolled and randomly divided into two groups of equal size with 30 women in each group. The frequency and severity of PDPH was compared between 25G cutting and non cutting needles in patients under going elective cesarean section under spinal anaesthesia. Results: The average age of the patients was 30.23 ± 6.6 years and 31.34 ± 5.6 in group I and group II respectively. There was no difference in baseline characteristics between groups as shown in Table 2. Lumbar puncture was successful in most of the patients in first attempt, 17 (90%) and 25 (83.3%) in group I and group II respectively. Out of 60 patients, 21.7% (13/60) patients had developed post dural puncture headache. Eleven (36.7%) of 30 patients had observed post dural puncture headache in group-I (25G cutting needles) and only 2 of 30 patients (6.7%) in group-II (25G non cutting needles). Severity of post dural puncture headache was significantly high in group-I than group-II on day 2 and day 3, (Chi-square test=8.56, df=3, P=0.036). None of the patients had traumatic punctures. Conclusion: The frequency and severity of PDPH was higher in 25G cutting spinal needle group as compared to non cutting needle.

Back to the scanner: expected and unexpected imaging findings following spinal puncture and access

Spinal canal procedures to withdraw fluid or introduce drugs are common minimally invasive techniques after which patients may experience new symptoms causing presentation to the emergency department. CT or MR imaging as part of the diagnostic workup may reveal expected or unexpected findings which may explain these symptoms. Small foci of gas within the spinal canal or intracranial compartment are common but are usually self-limited. Postlumbar puncture headache, presumed to be due to intracranial hypotension, may manifest on brain MR as dural thickening and low-lying cerebellar tonsils. Treatment with a blood patch is sometimes required for persistent symptoms. Spinal subarachnoid hemorrhage may be a devastating complication of dural puncture and may result in pain and paraplegia. In this review, technical details of these procedures are described and examples of common and uncommon postprocedure appearances on imaging are presented.

Cranial subdural haematoma: a rare complication of spinal anaesthesia

Cranial subdural haematoma: a rare complication of spinal anaesthesia

Chronic Back Pain Secondary to a Calcified Epidural Blood Patch

Chronic Back Pain Secondary to a Calcified Epidural Blood Patch

Dural Puncture and Subdural Injection: A Complication of Lumbar Transforaminal Epidural Injections

Two cases are presented in which the complication of dural puncture is documented in the context of a lumbar transforaminal epidural steroid injection. The hazard of dural puncture during transforaminal epidural injections, the anatomy of the dural and thecal sac, the potential for subdural injections, and relevant literature are reviewed. Report of two cases. Lumbar transforaminal epidural steroid injections are a commonly employed procedure for the treatment of lumbar radiculopathy. The optimal target point lies at the "6 o' clock" position of the pedicle. Contrast is injected to confirm proper placement of the needle and correct flow of the medication through the epidural space. Despite apparent proper placement of the needle, a potential complication exists of puncturing the dura while performing this procedure. Spinal injectionists should recognize the subsequent contrast patterns associated with this complication. Subdural and intrathecal spread of contrast is rarely seen with transforaminal injections and thus can be easily overlooked. Becoming familiar with the images presented in these cases may help alert the interventionalist of a dural puncture, and thus avoid injection of medications into the intrathecal and subdural spaces.

Diplopia: a complication of dural puncture.

Diplopia: a complication of dural puncture.

Hématome sous-dural intracrânien après brèche dure-mérienne en obstétrique

The authors report a case of subdural haematoma (HSD), which occurred following epidural analgesia for labour, complicated by post dural puncture headache (PDPH). A 26-year-old woman displayed a typical PDPH following epidural anaesthesia. On the sixth day, she was given a blood patch (BP), which was partially efficacious. Because of worsening of the headache, of disappearance of the postural characteristics, and of vomiting without focal neurological signs on the 9 th day, a CT-scan was done. The CT-scan showed a small hemispheric subdural haematoma. The recovery was complete with only medical treatment. HSD is a rare serious complication of dural puncture. When the characteristics of PDPH change, HSD should be evoked even without focal neurological signs. An early diagnosis and the small size of the haematoma may allow HSD to be treated medically and avoid surgical evacuation.