The intradural space: the fourth place to go astray during epidural block

International Journal of Obstetric Anesthesia
Clive Collier

Abstract

Considerable uncertainty exists regarding accidental injection of local anaesthetic into the 'subdural space' during attempted epidural block. A whole range of clinical findings, from excessively high to failed blocks has been reported although many of these findings appear difficult to explain on the basis of our current knowledge of the anatomy. The existence of another, adjacent space, the intradural space, is postulated. Our study of atypical epidural blocks using contrast injection and radiographic screening has now obtained data on 130 patients, and results were reviewed retrospectively, searching for contrast flowing into the subdural region. Radiographic studies have revealed 10 patients with an unusual dense localised collection of contrast in a space previously unrecognised by anaesthetists. Clinical presentation was of inadequate neuraxial block, which could eventually be corrected by top-up doses, but with the possible risk of developing a high block. Late radiographic pictures revealed contrast escaping from the mass into the epidural, subdural or subarachnoid spaces. A review of electron microscopy studies suggested that a 'secondary' subdural space could be opened up by trauma in the distal layers of the dura. Ou...Continue Reading

References

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Citations

Oct 13, 2011·Regional Anesthesia and Pain Medicine·Miguel Angel ReinaJosé Antonio De Andrés
Dec 7, 2010·International Journal of Obstetric Anesthesia·G FeiglH Bornemann-Cimenti
Jun 10, 2008·Journal of Critical Care·Orit Manor-ShulmanChristopher S Parshuram
Apr 15, 2011·Korean journal of anesthesiology·Joo Sun YunYoun-Woo Lee
Oct 15, 2019·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Jatinder GillMoris Aner
Dec 15, 2011·Anaesthesia and Intensive Care·C B CollierF Machés
Jun 13, 2017·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Timothy Maus
Jun 13, 2017·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Jatinder S Gill

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