Subdural block following epidural labor analgesia: A case report

Abstract

Rationale: Epidural labor analgesia is a widely accepted technique for adequate pain relief during childbirth. It has gained popularity in recent decades because it ensures good analgesia and comfort for the parturient. This technique sometimes leads to complications such as subdural blocks.

Patient concerns: A 25-year-old full-term pregnant woman developed motor weakness and a sensory block to T8 20 minutes after the medication was given, followed by hypotension and sensory block to T2.

Diagnoses: The woman developed a subdural block after epidural labor analgesia at the L2-L3 interspace.

Interventions: Norepinephrine and atropine stabilized her vital signs, while fetal monitoring remained stable.

Outcomes: With treatment, the woman delivered a healthy newborn with an Apgar score of 10. A postpartum computed tomography scan excluded subarachnoid involvement, and the catheter was removed without further complications.

Lessons: The vital signs, motor block, and pain were closely monitored and provided indications for the early detection of subdural blocks in this case report. The good prognosis of this case and no complications after delivery also suggested an early detection, timely treatment, and well-set management of subdural blocks can minimize the grave outcomes of the subdural blocks.

Keywords: case report; complications; epidural; labor analgesia; subdural block.

Figure 1.

CT images. (A) Sagittal view of the CT spine demonstrating epidural catheter (arrow) that extends in via the midpoint of the L2–3 interspinous space at the vertebral level of L3. (B) Sagittal view of the CT spine showing the epidural catheter (arrow), which after its deviation from the midline is located at the right side close to the L3–4 intervertebral foramen. (C) Transverse view of the CT spine showing the epidural catheter (arrow) continues to course significantly off midline to the right posterior lower aspect of the L3 vertebral body.