The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Inadvertent Dural Puncture during Caudal Approach by the Introducer Needle for Epidural Adhesiolysis Caused by Anatomical Variation

  • Kim, Si Gon (Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine) ;
  • Yang, Jong Yeun (Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine) ;
  • Kim, Do Wan (Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine) ;
  • Lee, Yeon Ju (Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine)
  • Received : 2012.12.06
  • Accepted : 2012.12.26
  • Published : 2013.04.01
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Abstract

There have been reports of abnormalities in the lumbosacral region involving a lower-than-normal termination of the dural sac, which is caused by disease or anatomical variation. Inadvertent dural puncture or other unexpected complications can occur during caudal epidural block or adhesiolysis in patients with these variations, but only a small number of case reports have described this issue. We report a case of dural puncture by the introducer needle before attempting caudal epidural adhesiolysis, which occurred even though the needle was not advanced upward after penetrating the sacrococcygeal ligament. Dural puncture was caused by a morphological abnormality in the lumbosacral region, with no pathological condition; the dural sac terminal was located more distally than normal. However, dural puncture could have been prevented if we had checked for such an abnormality in the magnetic resonance imaging (MRI) taken before the procedure.

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References

  1. Meyer RJ. Dural puncture via the sacral hiatus. Anaesthesia 1984; 39: 610. https://doi.org/10.1111/j.1365-2044.1984.tb07393.x
  2. Park BC, Kim BS, Hwang WJ, Lee J, Moon DE. Anatomical variations which can result in inadvertent dural puncture when performing caudal block: a report of 3 cases. Korean J Anesthesiol 2006; 50: 332-336. https://doi.org/10.4097/kjae.2006.50.3.332
  3. Kang MS, Lim YJ, Lee SC. Sacral meningeal cyst detected during caudal epidural block. J Korean Pain Soc 1999; 12: 258-262.
  4. Joo J, Kim J, Lee J. The prevalence of anatomical variations that can cause inadvertent dural puncture when performing caudal block in Koreans: a study using magnetic resonance imaging. Anaesthesia 2010; 65: 23-26. https://doi.org/10.1111/j.1365-2044.2009.06168.x
  5. Lubenow T, Keh-Wong E, Kristof K, Ivankovich O, Ivankovich AD. Inadvertent subdural injection: a complication of an epidural block. Anesth Analg 1988; 67: 175-179. https://doi.org/10.1213/00000539-198802001-00175
  6. Racz GB, Holubec JT. Lysis of adhesion in the epidural space. Techniques of neurolysis. Boston, Kluwer Academic. 1989, pp 57-72.
  7. Evison G, Windsor P, Duck F. Myelographic features of the normal sacral sac. Br J Radiol 1979; 52: 777-780. https://doi.org/10.1259/0007-1285-52-622-777
  8. Larsen JL, Olsen KO. Radiographic anatomy of the distal dural sac. A myelographic investigation of dimensions and termination. Acta Radiol 1991; 32: 214-219. https://doi.org/10.3109/02841859109177551
  9. Macdonald A, Chatrath P, Spector T, Ellis H. Level of termination of the spinal cord and the dural sac: a magnetic resonance study. Clin Anat 1999; 12: 149-152. https://doi.org/10.1002/(SICI)1098-2353(1999)12:3<149::AID-CA1>3.0.CO;2-X
  10. Aggarwal A, Kaur H, Batra YK, Aggarwal AK, Rajeev S, Sahni D. Anatomic consideration of caudal epidural space: a cadaver study. Clin Anat 2009; 22: 730-737. https://doi.org/10.1002/ca.20832
  11. Waldman JD. Pain management. 2nd ed. Philadelphia, Elsevier Saunders. 2011, pp 248-256.

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