[Iterative epidural anesthesia after accidental dural puncture. Analysis with epidurography]. 1991

M E Gentili, and K Samii
Service d'Anesthésie-Réanimation, Clinique Sainte-Anne, Gourin.

The case is reported of a 63-year-old man who was to undergo a gastrectomy for stomach carcinoma. An epidural catheter for postoperative analgesia (epidural morphine) was inserted into the T10-11 space prior to induction of general anaesthesia. Unfortunately, cerebrospinal fluid (CSF) surged back through the Tuohy needle, which was immediately withdrawn. It was decided to make a further attempt at the L2-3 level. This was successful, and no CSF could be aspirated through the catheter. Four hours after recovery, and epidurography was carried out (12 ml of lopamiro R 300). This revealed passage of contrast, medium from the epidural space into the subarachnoid space, with opacification of the caudal cul-de-sac. Another epidurography, 24 hours later, showed the same picture. The analgesic technique was therefore altered to subcutaneous buprenorphine. Careful management of this situation, in order to prevent total spinal anaesthesia, is discussed in the light of the literature.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009339 Needles Sharp instruments used for puncturing or suturing. Hypodermic Needles,Hypodermic Needle,Needle,Needle, Hypodermic,Needles, Hypodermic
D011859 Radiography Examination of any part of the body for diagnostic purposes by means of X-RAYS or GAMMA RAYS, recording the image on a sensitized surface (such as photographic film). Radiology, Diagnostic X-Ray,Roentgenography,X-Ray, Diagnostic,Diagnostic X-Ray,Diagnostic X-Ray Radiology,X-Ray Radiology, Diagnostic,Diagnostic X Ray,Diagnostic X Ray Radiology,Diagnostic X-Rays,Radiology, Diagnostic X Ray,X Ray Radiology, Diagnostic,X Ray, Diagnostic,X-Rays, Diagnostic
D004388 Dura Mater The outermost of the three MENINGES, a fibrous membrane of connective tissue that covers the brain and the spinal cord. Falx Cerebelli,Falx Cerebri,Pachymeninx,Tentorium Cerebelli
D004824 Epidural Space Space between the dura mater and the walls of the vertebral canal. Epidural Spaces,Space, Epidural,Spaces, Epidural
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000775 Anesthesia, Spinal Procedure in which an anesthetic is injected directly into the spinal cord. Anesthesias, Spinal,Spinal Anesthesia,Spinal Anesthesias
D013346 Subarachnoid Space The space between the arachnoid membrane and PIA MATER, filled with CEREBROSPINAL FLUID. It contains large blood vessels that supply the BRAIN and SPINAL CORD. Space, Subarachnoid,Spaces, Subarachnoid,Subarachnoid Spaces
D014950 Wounds, Penetrating Wounds caused by objects penetrating the skin. Penetrating Wound,Penetrating Wounds,Wound, Penetrating

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