Background: Regional anesthesia techniques, including neuraxial anesthesia, are common anesthetic modalities used in orthopedic surgery. Despite their advantages, there can be complications.
Objectives: This article describes a case of pneumocephalus following a combined spinal-epidural (CSE) anesthesia with the “loss of resistance to air” (LORA) technique to the identification of the epiduralspace.
Case report: A 78-year-old women ASA III was proposed for a partial hip replacement. We used a CSE anesthesia which proved difficult but was finally achieved after multiple attempts. Immediately after the procedure, the patient was unconscious, without any voluntary movements or response to call, maintaining spontaneous respiration and hemodynamically stable. This situation reversed in about 30 minutes. Cranial CT scan reveled multiple intracranial air collections. The patient recovered with no other symptoms related to pneumocephalus.
Conclusions: There are little advantages in using the LORA technique and there are rare but potentially severe complications of its use. Therefore its use must be weighted/ we discourage its practice.
References:
1. Gómez-Ríos MÁ, M.D., Fernández-Goti MC, M.D. Pneumocephalus after inadvertent dural puncture during epidural anesthesia. Anesthesiology 2013; 118(2):444
2. Bolster F, M.D., Carty F, M.D., Crosbie I, M.D., Ryan J, M.D., Colreavy F, M.D. A preoperative headache. Anesthesiology 2013; 119:121
3. Grondin LS, M.D., Nelson K, M.D., Ross V, M.D., Aponte O, M.D., Lee S, M.D., Pan PH, M.D. Success of Spinal and Epidural Labor Analgesia. Comparison of Loss of Resistance Technique Using Air versus Saline in Combined Spinal-Epidural Labor Analgesia Technique. Anesthesiology 2009; 111:165–172

02 / Pneumocephalus following combined spinal-epidural anesthesia – A Case Report