title: Hyperbaric therapy for a postpartum patient with prolonged epidural blockade and tomographic evidence of epidural air.
abstract: We used the epidural technique "loss of resistance to air" to provide labor analgesia in a healthy parturient. Inadequate analgesia required epidural catheter replacement using the same technique. Delayed recovery of sensory and motor blockade postpartum necessitated computed tomography and magnetic resonance imaging studies. These revealed 4-6 mL of air in the epidural space with no evidence of thecal compression. On the advice of the neurologist, this patient underwent hyperbaric therapy 14 h after the discontinuation of the epidural infusion. The patient made a complete recovery and was discharged without neurologic sequelae. It is possible that epidural air delayed the absorption of local anesthetics as a result of a reduction in the vascular surface area. Although a cause and effect relationship between epidural air and prolonged neurological block cannot be categorically established, the use of "loss of resistance to air" technique complicated the differential diagnosis.
  
  
  CONCLUSIONS
  We report a case of prolonged motor and sensory block after labor analgesia using "loss of resistance to air" technique. The presence of epidural air on tomography resulted in the patient undergoing hyperbaric therapy. The use of loss of resistance to air technique complicated the differential diagnosis of prolonged sensory and motor block.
authors: From the Department of Anesthesiology and Perioperative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts and the *Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
authors: Moeen K
authors: MK
authors: Panni
authors: William
authors: W
authors: Camann
authors: Kodali
authors: K
authors: Bhavani Shankar
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D004618:Embolism, Air / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D014057:Tomography, X-Ray Computed