Arachnoid herniation with needle trauma in regional anaesthesia: Case report

Öz

Background: Spinal and epidural blocks are accepted techniques for regional anaesthesia, and lumbarpuncture is the way of application anaesthesia. Lumbar puncture is a procedure associated with minimalrisk. Slight contact of the needle tip to the dura mater can cause perforation. Serious complications arerelatively rare. Case Report: We report a rare case of an arachnoid herniation, occurred after regionalanaesthesia. Arachnoid herniation was seen incidentaly during the third operation for lumbar back and legpain. Dural defect is primarily repaired additional to the decompression and posterior stabilization.Conclusion: Although spinal and epidural procedure is widely used for anaesthesia, it may rarely causecomplications. Arachnoid herniations can be seen with the minor dural trauma from inserting the epiduraltube or spinal puncture. Needle gauche is important during regional anaesthesia not to cause complications

Anahtar Kelimeler

• arachnoid herniation
• epidural anaesthesia
• dural injury

Rejyonel anestezi sýrasýnda iðne travmasýna baðlý oluþan araknoid herniasyon: olgu sunumu

Öz

Spinal ve epidural bloklar rejyonel anestezide kullanilan tekniklerdir ve lombe ponksiyon yolu ile anestezi uygulanir. Lomber ponksiyon minimal riski olan bir yontemdir. Igne ucunun dura matere hafif bir temasi perforasyona neden olabilir. Ciddi komplikasyonlar cok nadir olarak gorulebilir. Olgu: Bu calismada, rejyonel anestezi sonrasinda araknoid herniasyon meydana gelen bir olgu sunulmustur. Araknoid herniasyon rastlantisal olarak bel ve bacak agrisi nedeni ile yapilan ucuncu operasyon sirasinda gorulmustur. Dekompresyon ve posterior stabilizasyona ek olarak dura defekti primer tamir edilmistir. Sonuc: Spinal ve epidural yontemler oldukca sik kullanilmalarina ragmen nadiren komplikasyonlar gelisebilmektedir. Epidural tup yerlestirme veya spinal ponksiyon sirasinda minor dural travma ile araknoid herniasyon gorulebilmektedir. Rejyonel anestezi esnasinda komplikasyonlara neden olmamak icin ignenin boyutlari onem kazanmaktadir. 

Anahtar Kelimeler

• araknoid herniasyon
• epidural anestezi
• dural hasar

Kaynakça

1. Pitkanen MT, Aromaa U, Cozanitis DA, Forster JG. Serious complications associated with spinal and epidural anaesthesia in Finland from 2000 to 2009. Acta Anaesthesiol Scand 2013;57:553-564
2. Zarzur E, Goncalves JJ. The resistance of the human dura mater to needle penetration. Regional Anaesthesia 1992;17:216-218
3. Hirai T, Kato T, Kawabata S, enomoto M, Tomizawa S, Yoshii T, Sakaki K, Shinomiya K. Adhesive arachnoiditis with extensive syringomyelia and giant arachnoid cyst after spinal and epidural anaesthesia. Spine 2012;37(3):E195- E198
4. Steinfeldt T, Nimphius W, Werner T, et al. Nerve injury by needle nerve perforation in regional anaesthesia: does size matter? Br J Anaesth 2010;104(2):245-253
5. Reina MA, Dittmann M, Garcia AL, van Zundert A. New prospectives in the microscopic structure of human dura mater in the dorsolomber region. Reg Anaesth 1997;22:161-6
6. Reina MA, De Leon Casacola O, Lopez A,De Andres JA, Mora M, Fernandez A. The orijin of the spinal subdural space: ultrastructural findings. Anesth Analg 2002;94:991-5
7. Hardy PAJ. Can epidural catheters penetrate dura mater? An anatomical study. Anaesthesia 1986;80:747-53
8. Fink BR, Walker S. Orientation of fibers in human dorsal lumbar dura mater in relation to lumbar puncture. Anaesth Analg 1989;69:768-772

9. Reina MA, Collier CB, Prats-Galino A, Puigdellivol-Sanchez A, Maches F, Andres JA. Unintentional subdural placement of epidural catheters during attempted epidural anaesthesia. Regional Anaesthesia and Pain Medicine 2011;36(6):537-541
10. Ng WH, Drake JM. Symptomatic spinal epidural CSF collection after lumbar puncture in a young adult: case report and review of literature. Childs Nerv Syst 2010;26:259-262
11. Mehta M, Salmon N. Extradural block. Confirmation of the injection site by x-ray monitoring. Anaesthesia 1983;40:1009-1012
12. Selander D, Dhuner KG, Lundborg G. Perkpheral nerve injury due to injection needles used for regional anaesthesia. An experimental study of the acute effects of needle point trauma. Acta Anaesthesiol Scand 1977;21(3):182-188
13. Sala-Blanch X,Ribalta T, Rivas E, et al. Structurel injury to the human siatic nerve after intraneural needle insertion. Reg Anesth Pain Med 2009;34(3):201-205