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

Abstract

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 Unfortunately, cerebrospinal fluid (CSF) surged back through the Tuohy needle, which was immediately withdrawn.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.