Marinho Ramiro, Sousa Mara, Machado Filipa, Fonseca Sara, Guedes Luísa
Department of Anesthesiology, Centro Hospitalar S. João, Largo do Prof. Abel Salazar 4099-001, Porto, Portugal.
Scand J Pain. 2018 Oct 25;18(4):739-741. doi: 10.1515/sjpain-2018-0073.
Cerebrospinal fluid cutaneous fistula is a rare but potentially serious complication of epidural analgesia. We report the case of a patient submitted to total knee arthroplasty under subarachnoid block and placement of lumbar epidural catheter for post-operative analgesia. The epidural catheter was found exteriorised on the fourth post-operative day, and the patient presented with a moderate fluid leak from the puncture site that was confirmed to be cerebrospinal fluid by cytological and chemical analysis. The initial therapeutic approach consisted of bed rest, hydration and prophylactic antibiotic therapy for 3 days, but it was ineffective as the leak persisted. A suture was placed at the epidural insertion site with immediate resolution of the leak. The suture was maintained for 5 days. The patient progressed satisfactorily without requiring further therapies.
脑脊液皮肤瘘是硬膜外镇痛一种罕见但可能严重的并发症。我们报告一例患者，其在蛛网膜下腔阻滞下行全膝关节置换术，并放置腰椎硬膜外导管用于术后镇痛。术后第4天发现硬膜外导管外露，患者穿刺部位有中度液体渗漏，经细胞学和化学分析证实为脑脊液。初始治疗方法包括卧床休息、补液和预防性抗生素治疗3天，但由于渗漏持续存在，治疗无效。在硬膜外穿刺部位进行缝合，渗漏立即停止。缝线保留5天。患者恢复良好，无需进一步治疗。
