The lumbar epidural analgesia is commonly used for labour analgesia. The “loss
of resistance to air” LORA technique is commonly used for recognition of epidural
space. One of the rare complications of this technique is Pneumocephalus (PC).
We want to present a case of Pneumocephalus which the mother developed
during epidural analgesia in labour. The patient complained of severe headache
immediately after second attempt at epidural catheter insertion. The symptoms
progressively worsened following delivery. A postnatal anaesthetic review
was performed and an urgent CT scan of the brain was arranged that showed
pneumocephalus. A conservative management pathway was followed with liberal
analgesia, oxygen inhalation and keeping the patient mostly in supine position.
Her symptoms regressed in severity over the next three days and subsided after
one week. We believe that the amount of air used for LORA should be minimized;
LORA should not be used after dural puncture and the use of normal saline would
alleviate the risk.
Rafiq S, Abbasher I and Denona B