Case Report: Pneumocephalus after labor epidural anesthesia

Abstract

Lumbar epidural anesthesia is commonly used for labor analgesia. The 'loss-of- resistance' to air technique (LORA) is generally employed for recognition of the epidural space. One of the rare complications of this technique is pneumocephalus (PC). Here we describe the case of a parturient who developed a frontal headache when locating the epidural space using LORA. On the second day after epidural injection, the patient exhibited occipital headaches with gradual worsening. Computed tomography scans of the brain indicated PC. Following symptomatic treatment, our patient was discharged on the 13th day. We concluded that the amount of air used to identify the epidural space in LORA should be minimized, LORA should not be used after dural puncture and the use of saline avoids PC complications.

Figure 1.. Axial CT scan shows the presence of a gas bubble in the ventricular system following dural puncture, in the right frontal cistern horn of the lateral ventricle.

Figure 2.. Axial CT scan shows the presence of a gas bubble in the ventricular system following dural puncture, in both temporal cistern horns.