Persistent cerebrospinal fluid leak: a complication of the combined spinal-epidural technique.
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 beta(2)-transferrin immunofixation assay as a diagnostic test for the presence of CSF in this situation.


CONCLUSIONS
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.
Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Perth, Western Australia. sputnik5@iinet.net.au
Brian O
BO
Chan
Michael J
MJ
Paech
D000328:Adult; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D002555:Cerebrospinal Fluid / Q000502:physiology*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D008614:Meperidine / Q000008:administration & dosage / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy; D011247:Pregnancy; D014168:Transferrin / Q000134:cerebrospinal fluid; D014427:Twins
D000701:Analgesics, Opioid; D014168:Transferrin; D008614:Meperidine