![]() ![]() CSEA resulted in an inadequate block at the level of Th12. There were no signs of CSF backflow nor blood backflow through the needle or the catheter. We injected 8 mg of hyperbaric bupivacaine and 20 μg of fentanyl intrathecally, and placed a 17-gauge Perifix® catheter (B Braun, Tokyo, Japan) epidurally. CSEA was again performed at the 元–4 interspace using an identical 16-gauge needle, with a loss of resistance to saline at 3.0 cm followed by an uneventful needle-through-needle spinal tap. The epidural needle was immediately removed. At this time, we identified UDP with a constant stream of clear cerebrospinal fluid. On advancing the spinal needle, the patient experienced radiating pain in her right leg, which, unfortunately, caused her to move. A 27-gauge pencil point needle was introduced by 5 mm. Loss of resistance to saline was noted at 3.3 cm using a median approach. A 16-gauge CSEcure® needle (Smiths Medical Japan, Tokyo, Japan) was inserted at the L2–3 interspace. Eighty-three percent alcohol with 0.5% chlorhexidine was used for skin preparation. The patient was placed in a right lateral recumbent position. Combined spinal-epidural anesthesia (CSEA) was planned for the surgery. ![]() Her past, pertinent medical history was unremarkable. This condition was diagnosed clinically and identified using MRI.Ī 40-year-old Japanese primigravida with American Society of Anesthesiologists Performance Status 1 was scheduled for an elective cesarean section because of a low-lying placenta at 38 weeks of gestation. We present a case of subacute subdural hematoma and adhesive arachnoiditis following two courses of AEBP, one of which was performed at the interspace of UDP. Early diagnosis is important because these conditions may mimic others that require expedited interventions, including abscess formation. These conditions can be suspected clinically and identified by magnetic resonance imaging (MRI). In AEBP, blood may enter the subdural space by direct injection or through another dural hole caused by multiple attempts to locate the epidural space. Subdural blood causes adhesive arachnoiditis by releasing free radicals, which inflame pia and arachnoid mater, causing localized fibrosis. Inadvertent injection of blood into the subarachnoid space may result in subdural hematoma and adhesive arachnoiditis, which may lead to permanent nerve damage. Rare, severe neurological complications of AEBP have been reported, in addition to common issues, including post-procedural pain in the low back, buttock, or leg. Multiple courses of AEBP may be necessary. Treatment options include autologous epidural blood patch (AEBP), in which blood is injected into the epidural space this may alleviate symptoms by causing continued tamponade, adhering to the dural sac for an extended period of time at extended vertebral levels, thereby restoring intracranial pressure and reducing cerebral vasodilation. Rapid treatment for PDPH is indicated in the obstetric population because severe symptoms can prevent mother-neonate interactions. Unintentional dural puncture (UDP) by epidural needle complicates the care of 1.5% of obstetric patients post-dural-puncture headache (PDPH) is a common complication.
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