Background. Pneumocephalus developed in a 45-year-old woman after epidural anesthesia was performed to treat her low back pain. The cause was thought to be the loss of resistance to air technique. The clinical symptoms were immediate headache independent of posture, pallor, bradycardia, and hypotension. These symptoms disappeared during the first 24 hours with no neurologic sequelae.

Conclusion. This case suggests that using the loss of resistance technique with saline versus air should prevent this complication, especially after unintentional dural puncture or when, in difficult placements, the technique is repeated frequently in the same patient.