Management of Inadvertent Dural Puncture Following Thoracic Epidural anesthesia for Mastectomy: A Case Report

Monday Nwizor Nkadam *

Rivers State University, Rivers State University Teaching Hospital, Port Harcourt, Nigeria.

Sunday Imasuen

PAMO University of Medical Sciences, Rivers State University Teaching Hospital, Port Harcourt, Nigeria.

Rex Friday Ogoronte Alderton Ijah

Rivers State University, Rivers State University Teaching Hospital, Port Harcourt, Nigeria.

*Author to whom correspondence should be addressed.


Abstract

Background: Thoracic Epidural has been successfully used to administer anesthesia for mastectomy. However inadvertent dural puncture is a major complication occurring in about 0.19 to 3.6% during epidural anesthesia, even in very experienced hands with need for immediate and proper management. We present a case of mastectomy done under thoracic epidural anesthesia following inadvertent dural puncture, using same interspace.

Case Presentation: A 62-year-old known hypertensive female patient with good drug compliance, weighing 68kg and 1.68m in height with stage IV right breast cancer. She underwent modified radical right mastectomy, under thoracic epidural anesthesia administered at the T8/T9 interspace using an 18G Tuohy needle. Although there was inadvertent dural puncture, patient recovered without untoward effects.

Conclusion: Epidural anesthesia can be undertaken in the same interspace following accidental dural puncture if necessary precautions are taken.

Keywords: Thoracic epidural anesthesia, inadvertent dural puncture, mastectomy, Port Harcourt, Nigeria


How to Cite

Nkadam , M. N., Imasuen , S., & Ijah , R. F. O. A. (2024). Management of Inadvertent Dural Puncture Following Thoracic Epidural anesthesia for Mastectomy: A Case Report. International Journal of TROPICAL DISEASE & Health, 45(6), 127–132. https://doi.org/10.9734/ijtdh/2024/v45i61545

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References

Fyneface-Ogan S. Anatomy and clinical importance of the epidural space. Epidural Analgesia-Current Views and Approaches. 2012;12:1-12.

Trikha A, Sadhasivam S, Saxena A, Arora MK, Deo S. Thoracic epidural anesthesia for modified radical mastectomy in a patient with cryptogenic fibrosing alveolitis: a case report. Journal of clinical anesthesia. 2000;12(1):75-9.

Berger CW, Crosby ET, Grodecki W. North American survey of the management of durai puncture occurring during labour epidural analgesia. Canadian journal of anaesthesia. 1998;45:110-4.

Gleeson C, Reynolds F. Accidental dural puncture rates in UK obstetric practice. International Journal of Obstetric Anesthesia. 1998;7(4):242-6.

Choi PT, Galinski SE, Takeuchi L, Lucas S, Tamayo C, Jadad AR. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews. Centre for Reviews and Dissemination (UK); 2003.

Apfel C, Saxena A, Cakmakkaya O, Gaiser R, George E, Radke O. Prevention of postdural puncture headache after accidental dural puncture: a quantitative systematic review. British journal of anaesthesia. 2010;105(3):255-63.

Cesur M, Alici HA, Erdem AF, Silbir F, Celik M. Decreased incidence of headache after unintentional dural puncture in patients with cesarean delivery administered with postoperative epidural analgesia. Journal of anesthesia. 2009;23:31-5.

Sundarathiti P, Pasutharnchat K, Kongdan Y. Thoracic epidural anesthesia (TEA) with 0.2% ropivacaine in combination with ipsilateral brachial plexus block (BPB) for modified radical mastectomy (MRM). J Med Assoc Thai. 2005;88(4):513-20.

Ok SY, Park SW, Kim SI, Kim SC, Lee MH. Thoracic Epidural Anesthesia for Mastectomy. Korean Journal of Anesthesiology. 2006;50(6):646-9.

Belzarena SD. Comparative study between thoracic epidural block and general anesthesia for oncologic mastectomy. Revista brasileira de Anestesiologia. 2008;58:561-8.

Helal SM, Aziz AAA, Gab-Allah KA, Ramadan EG. Comparative study between thoracic epidural and ultrasound-guided thoracic paravertebral block in perioperative pain management for mastectomy. Menoufia Medical Journal. 2019;32(4):1191.

Srivastava A, Jamil S, Khandelwal A, Raj M, Singh S. Thoracic epidural anesthesia for modified radical mastectomy in a high-risk patient: A case report with literature review. Cureus. 2021;13(6).

Abdel-Momen MA, Elkhateeb SEM, Abdel-Raoof HS, Mohamed MAE. Comparative study between ultrasound guided pectoral nerves block and thoracic epidural as analgesia in breast surgeries. The Egyptian Journal of Hospital Medicine. 2018;72(9):5304-12.

Etta OE, Umeh K, Akpan SG. Thoracic epidural anaesthesia for major abdominal surgeries: experience in private hospital setting in Uyo, South-South Nigeria. Southern African Journal of Anaesthesia and Analgesia. 2016;22(3):17-9.

Rukewe A, Afuwape OO, Ugheoke A, Fatiregun AA. Single-shot lamina thoracic paravertebral block with ketofol for modified radical mastectomy. Local and Regional Anesthesia. 2016:83-6.

Etta OE, Udeme N. Thoracic epidural for modified radical mastectomy in a high-risk patient. Malawi Medical Journal. 2017;29 (1):61-2.

Giebler RM, Scherer RU, Peters J. Incidence of neurologic complications related to thoracic epidural catheterization. The Journal of the American Society of Anesthesiologists. 1997;86(1):55-63.

Scherer R, Schmutzler M, Giebler R, Erhard J, Stöcker L, Kox W. Complications related to thoracic epidural analgesia: A prospective study in 1071 surgical patients. Acta anaesthesiologica scandinavica. 1993;37(4):370-4.

Woodworth GE, Ivie RM, Nelson SM, Walker CM, Maniker RB. Perioperative breast analgesia: a qualitative review of anatomy and regional techniques. Regional Anesthesia & Pain Medicine. 2017;42(5):609-31.

Kaya M, Oğuz G, Şenel G, Kadıoğulları N. Postoperative analgesia after modified radical mastectomy: the efficacy of interscalene brachial plexus block. Journal of anesthesia. 2013;27:862-7.

Wenk M, Massoth C, Pöpping DM, Möllmann M. Feasibility of cervical epidural anesthesia for breast cancer surgery. Anesthesiology Research and Practice; 2017.