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OBSTETRIC ANESTHESIA

Persistent Cerebrospinal Fluid Leak: A Complication of the Combined Spinal-Epidural Technique

Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Perth, Western Australia

Address correspondence and reprint requests to Dr. Brian Chan, Department of Anaesthesia, Royal Perth Hospital, Perth, Australia. Address e-mail to sputnik5{at}iinet.net.au

Persistent cerebrospinal fluid (CSF) leak is an apparently rare complication of dural puncture from spinal or epidural anesthesia. Combined spinal-epidural techniques are increasingly popular but persistent CSF leak has not been reported. We describe three parturients with persistent fluid leak from the insertion site after epidural catheter removal following combined spinal-epidural anesthesia. Uncertainties related to the diagnosis, treatment, and the implications of this complication are discussed, including ß₂-transferrin immunofixation assay as a diagnostic test for the presence of CSF in this situation.

IMPLICATIONS: Combined spinal-epidural block can be complicated by persistent fluid leak from the skin insertion site. Testing for the presence of cerebrospinal fluid may be a useful aid to management.

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