Lower extremity radicular pain after prophylactic intrathecal saline injection through a subarachnoid catheter following accidental dural puncture

We describe a case in which severe lower extremity radicular pain occurred after administration of 0.9% saline into the subarachnoid space through a catheter that had been left for 20 h following inadvertent dural puncture in an obstetric patient. A 42-year-old (G8P7) woman was admitted for repeat cesarean delivery. Accidental dural puncture occurred during epidural placement. Following a slow 10-mL intrathecal injection of 0.9% normal saline an epidural catheter was advanced into the subarachnoid space. Spinal anesthesia was used for cesarean delivery and the subarachnoid catheter was kept in place for 20 h. Before catheter removal, an additional 10 mL of 0.9% saline was slowly administered into the intrathecal space. Almost instantly, the patient complained of back pain that progressed to lower extremity radicular pain and paresthesia; symptoms began to resolve after 10 min. Subsequently, the patient developed a postdural puncture headache that persisted for three days. The patient's radiculitis and paresthesia likely resulted from an acute increase in intrathecal pressure after saline administration or from direct catheter irritation. Although both intrathecal saline administration and subarachnoid catheter placement have been previously proposed as ways to prevent postdural puncture headache, their efficacy remains controversial, and we advise caution with these techniques. (C) 2011 Elsevier Ltd. All rights reserved.