Pneumomediastinum: A Rare Complication of Epidural Analgesia

Naik, Vibhavari; Nusrath, Syed; Rayani, Basanth Kumar; Reddy, Pratap K.; Yalamnchilli, Rohit

doi:10.7759/cureus.18747

Cited by 1 publication

(1 citation statement)

References 11 publications

(14 reference statements)

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“…A thoracic epidural was also performed for post-operative analgesia. The patient was managed conservatively and he too recovered fully [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic instability caused by pneumorrachis and pneumomediastinum following epidural analgesia: a case report

Fountoulaki,

Kapetanakis,

Kouna

et al. 2024

J Med Case Reports

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Background Pneumomediastinum and pneumorrachis are rare complications following epidural analgesia, that can either be asymptomatic or rarely can produce mild to moderate severity symptoms. Most reported cases regarding the presentation of these two entities with epidural analgesia concern asymptomatic patients, however there are cases reporting post-dural puncture headache and respiratory manifestations. Case presentation We present a case where a combined lumbar epidural and spinal anesthesia was performed using the loss of resistance to air technique (LOR), on a 78-year-old Greek (Caucasian) male undergoing a total hip replacement. Despite being hemodynamically stable throughout the operation, two hours following epidural analgesia the patient manifested a sudden drop in blood pressure and heart rate that required the administration of adrenaline to counter. Pneumomediastinum, pneumorrachis and paravertebral soft tissue emphysema were demonstrated in a Computed Tomography scan. We believe that injected air from the epidural space and surrounding tissues slowly moved towards the mediastinum, stimulating the para-aortic ganglia causing parasympathetic stimulation and therefore hypotension and bradycardia. Conclusion Anesthesiologists should be aware that epidural analgesia using the LOR to technique injecting air could produce a pneumomediastinum and pneumorrachis, which in turn could produce hemodynamic instability via parasympathetic stimulation.

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“…A thoracic epidural was also performed for post-operative analgesia. The patient was managed conservatively and he too recovered fully [ 12 ].…”

Section: Discussionmentioning

confidence: 99%