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

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.