Inyección subdural: complicación en la técnica peridural lumbar: revisión bibliográfica / Subdural injection: complication in lumbar epidural block: review of the literature

Se realiza una revisión bibliográfica sobre inyección subdural en la técnica peridural lumbar. se analizan los aspectos anatómicos, se describen las diferentes formas de presentación y su imagen radiológica, se discuten los criterios diagnósticos, los posibles efectos de la inyección en dicho espacio y la conducta a tomar, una vez detectada la complicación.

A bibliographic review about lumbar epidural subdural injection is done. the anatomic aspects, the different forms of presentation, and the radiological image are described. the diagnostic criteria, the effects of injection in this space and the management of the complication are discussed.

INYECCIÓN SUBDURAL: COMPLICACIÓN EN UN PROCEDIMIENTO EPIDURAL TRANSFORAMINAL LUMBAR

Se comunica un caso de inyección subdural accidental en el contexto de una inyección epidural transforaminal lumbar, con una aparente ubicación apropiada de la aguja. Se describen las imágenes observadas, se analizan las posibles complicaciones de la inyección en dicho espacio, y se discute la conducta a tomar una vez instalada la complicación.

A case on unexpected subdural injection despite apparent proper placement of the needle is reported. The watched images are described, the possible complications of the injection in this space are analyzed, and the proper conduct is discussed.

Stability of acute subdural hematoma in rats developed by subdural injection of different volumes of autologous blood / 中国比较医学杂志

ObjectiveToexplorethestabilityofratmodelsofsubduralhematomapreparedbysubduralinjection of different volumes of autologous blood .Methods The rats were randomly divided into sham group (36), 300μL blood group, 500 μL blood group, and 700 μL blood group (each group 60 rats).The rats of model groups received subdural injection of 300 μL, 500 μL, or 700 μL autologous blood, respectively.At the postoperative 2nd, 4th, 6th, 8th, 10th, 14th days, blood samples were taken from the abnormal aorta , and the brains were taken out for gross examination and taking photographs , six rats were used for each time .Enzyme linked immunosorbent assay ( ELISA ) was performed to determine the content of serum NSE and S100B proteins in the rats in each group.Results Compared with the sham operation group, the serum NSE in the 300μL group was significantly increased at the 2nd and 4th days (P0.05).In the 500 μL and 700 μL blood groups, the NSE contents at 2nd, 6th, 8th, 10th and 14th days were significantly increased ( P 0.05 ).The content of S100B protein in the 300 μL blood group was significantly higher at the fourth day (P0.05 for all ) , indicating that the hematoma disappeared gradually, and the damages repaired .The S100B protein content of the 500 μL and 700 μL blood groups was constantly kept at a higher level ( P<0.05 ) .Conclusions Compared with the 300 μL ad 700 μL blood groups , the rat model of subdural hematoma developed by subdural injection of 500 μL autologous blood is the best , and can be used for studies of rat subdural hematoma .

Intrauterine fetal bradycardia after accidental administration of the anesthetic agent in the subdural space during epidural labor analgesia: A case report / 대한마취과학회지

Subdural injection of epidural anesthesia is rare and is usually undiagnosed during epidural anesthesia causing severely delayed maternal hypotension, hypoxia, and fetal distress. A 38-year-old primiparous woman was administered epidural labor analgesia at 40(+6) weeks' gestation, and developed progressive maternal respiratory depression, bradycardia, and hypotension after accidental subdural administration of the anesthetic agent. Furthermore, fetal distress occurred soon after administration. The patient was managed with oxygen, position changes, fluid resuscitation, and ephedrine. Intrauterine fetal resuscitation was successfully performed with atropine before cesarean section, and a healthy baby was delivered. Although subdural injection is uncommon, this case emphasizes the importance of anesthesiologists monitoring patients for a sufficient period after epidural labor analgesia, and being prepared to perform maternal or fetal resuscitation.

Accidental intradural injection during attempted epidural block: A case report / 대한마취과학회지

Several cases of accidental subdural injection have been reported, but only few of them are known to be accidental intradural injection during epidural block. Therefore we would like to report our experience of accidental intradural injection. A 68-year-old female was referred to our pain clinic due to severe metastatic spinal pain. We performed a diagnostic epidural injection at T9/10 interspace under the C-arm guided X-ray view. Unlike the usual process of block, onset was delayed and sensory dermatomes were irregular range. We found out a dense collection of localized radio-opaque contrast media on the reviewed X-ray findings. These are characteristic of intradural injection and clearly different from the narrow wispy bands of contrast in the subdural space.

Accidental Subdural Injection during Attempted Cervical Epidural Block: Radiologic Evidence : A case report

Case reports after accidental subdural injection during attempted epidural block have usually described extensive neuraxial blocks with a characteristic radiographic appearance on contrast injection. We experienced a case of cervical subdural injection with unusual clinical findings and radiographic appearance. A 51-year-old female patient with central herniated nucleus pulposus at cervical (C5/6) and lumbar level (L4/5, L5/S1) was referred to the pain clinic. During attempted cervical epidural block at the C6/7 interspace with fluoroscopy, injection of the 4 ml contrast showed posterior spread at cervical level. After cervical epidural steroid injection, the contrast was also confined to the posterior aspect of the spinal canal at lumbar level with fluoroscopy. In order to discriminate subdural space from epidural space, we performed transforaminal epidural injection of the 2 ml contrast at the L5/S1 interspace and we could confirm cervical epidural injection was made into the subdural space. We discuss the clinical characteristics of a subdural injection and the appearance of the cervical and lumbar subdurogram.