Canadian Journal of Anesthesia, Vol 43, 1068-1071, Copyright © 1996 by Canadian Anesthesiologists' Society

ARTICLES

Surgical anaesthesia for Caesarean section with a subdural catheter

RY Gershon
Department of Obstetric Anesthesiology, Grady Health System, Emory University School of Medicine, Atlanta, Georgia 30303, USA. RGershon@anes.eushc.org

PURPOSE: This case report describes a radiologically proven subdural catheter placed in a term parturient, which consistently performed as an epidural catheter for both labour analgesia as well as surgical anaesthesia. CLINICAL FEATURES: The patient was a 26-yr-old, 52.7 kg. 140 cm healthy woman with a 39 wk intrauterine pregnancy. At initiation of epidural blockade, and for many hours throughout labour, an appropriate volume and concentration of local anaesthetic achieved an appropriate analgesic sensory level (10 ml bupivacaine 0.25%, bilateral T10 sensory level). However, for Caesarean section, while an appropriate volume and concentration of local anaesthetic achieved an appropriate surgical anaesthetic sensory level (15 ml bupivacaine 0.5%, bilateral T4 sensory level), there was no demonstrable motor blockade (0 on the Bromage scale). The Caesarean section was performed without incident, and without the need for supplemental intravenous opioids or anxiolytics. CONCLUSION: We report the case to question the commonly held beliefs of subdural catheter presentation. We questioned the catheter position, and proved its subdural placement, only after larger volumes of higher concentration local anaesthetic did not achieve expected goals. It is possible that a high percentage of epidural catheters may be subdural, unbeknownst to the practitioner.

This article has been cited by other articles:

				B. C.H. Tsui, S. Gupta, D. Emery, and B. Finucane Detection of subdural placement of epidural catheter using nerve stimulation Can J Anesth, May 1, 2000; 47(5): 471 - 473. [Abstract] [Full Text] [PDF]