Background and aims Neuraxial anesthesia is widely practiced in the obstetric population given its high success rate and safety profile. Despite its low rate of complications, when they do occur they are extremely inconvenient and can be disastrous in the obstetric setting. Cerebrospinal fluid cutaneous fistula is rarely reported as a consequence of neuraxial anesthesia but can lead to significant morbidity such as severe postural headaches, nausea, vomiting, meningitis or subdural hematoma.
Results A 31-year-old woman presented for an elective cesarean section. The chosen anesthetic technique was a spinal block and epidural catheter placement. The spinal block was performed with a 27-G Quincke needle and the epidural placed with an 18-G Tuohy needle, both uneventful. During the day of the procedure and the next 2 days, the epidural catheter was used for analgesia without complications. The catheter was removed the third day after the procedure and the patient noted a clear fluid leak from the catheter insertion site; protein and glucose analysis was consistent with cerebrospinal fluid. After neurosurgical consultation, the skin was sutured, with an apparent resolution of the leak. The patient remained asymptomatic and was discharged 3 days after.
Conclusions As the literature is scarce regarding this complication, there are no specific recommendations on its management. A conservative and expectant initial approach including bed rest and hydration is consensual, especially in the absence of symptoms. Cutaneous stitching, epidural blood patch and surgical correction are some of the reported treatments.
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