LP026 Not just a breeze: unveiling pneumocephalus as a rare complication of central regional anaesthesia

<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted:</b> Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission <h3>Background and Aims</h3> A 68-year-old male, ASA III, underwent a total knee arthroplasty under combined spinal-epidural anaesthesia. In the seated position, a Tuohy needle was inserted at the L3-L4 spinal segment. Using a saline solution, the epidural space was identified through the loss of resistance technique. The epidural catheter was placed 10cm from the skin. The procedure had no other complications. <h3>Methods</h3> On the third postoperative day, two hours after the removal of the epidural catheter, the patient reported an incapacitating frontal headache, facial paresthesias, a ‘distant voice’ feeling, and nausea/vomiting. After Neurology’s and Neurosurgery’s evaluations, a head CT was performed, revealing intraventricular aeroceles at the frontal and temporal horns of the lateral ventricles. A pneumocephalus following the epidural technique was assumed to be the cause. Rest, oral hydration, multimodal analgesia (acetaminophen, ketorolac, metamizole, tramadol SOS), and a short corticotherapy’s cycle were applied. Two days later, upon neurological and neuroimaging improvement, the patient was discharged. <h3>Results</h3> Pneumocephalus is a self-limited condition characterized by the presence of air in the epidural, subdural, or subarachnoid spaces[1]. Whichever the situation, the air pockets compress encephalic structures, increasing intracranial pressure and leading to multiple neurological manifestations (such as headache and focal neurological deficits), depending on the volume of air and its location[1,2]. The head CT is the gold standard for diagnosis. Treatment is primarily symptomatic (rest, a 30° head position, and analgesics), being high-flow oxygen, hyperbaric oxygen therapy, and surgery secondary options[1,3]. <h3>Conclusions</h3> This case underscores the importance of awareness in the prompt identification of neuraxial complications, despite their rarity.