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LETTERS TO THE EDITOR

Persistent Cerebrospinal Fluid Leak

Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, Kings Lynn, Norfolk, United Kingdom, Beverly.Watson@qehkl.nhs.uk, Dr. Chan does not wish to respond.

To the Editor:

We read with interest the case reports of Chan and Peach (1) concerning persistent cerebrospinal fluid (CSF) leak after combined spinal-epidural anesthesia. The authors state that the natural history and optimal management of persistent CSF leak from an epidural insertion site is uncertain. We report our experience of a parturient whose persistent CSF leak was treated expectantly with a favorable outcome.

A 24-year-old primigravid patient with spina bifida occulta presented to the obstetric anesthetic clinic to discuss analgesic options for labor and delivery. Risks and benefits of regional analgesia were discussed at this time and again when she requested epidural analgesia during labor. The epidural space was identified easily at L2/3, but the catheter immediately penetrated the dura and was therefore used to provide intrathecal analgesia for the remainder of the labor and delivery.

The catheter was removed after delivery, and the patient discharged on the following day when she was asymptomatic. She developed a mild postdural-puncture headache and a CSF leak from the Tuohy needle puncture site on the 2nd day postpartum. The headache resolved spontaneously on the 6th and the CSF leak on the 7th postpartum day and she has remained well since.

Reference

1. Chan BO, Paech MJ. Persistent cerebrospinal fluid leak: a complication of the combined spinal-epidural technique. Anesth Analg 2004; 98: 828–30[Abstract/Free Full Text]

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