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Cerebrospinal fluid fistula after combined spinal-epidural block
  1. Ana Isabel Pereira,
  2. Diana Lastra Fernandes,
  3. Ana Amorim and
  4. Sara Nunes
  1. Anaesthesia Department, Centro Hospitalar do Funchal, Funchal, Madeira, Portugal
  1. Correspondence to Dr Ana Isabel Pereira; 2502anaisabel{at}


Neuraxial anaesthesia is an essential technique in obstetric anaesthesia practice. Cerebrospinal fluid (CSF) fistula is a rare complication and there is no consensus about its clinical approach. We present a case of a 28-year-old nulliparous woman that developed a cutaneous CSF fistula following combined spinal and epidural block for caesarean delivery. After multidisciplinary discussion it was decided that hydration, absolute bed-rest and compressive dressing with abdominal binder was the best option and the patient fully recovered without any sequelae.

Based on literature, symptoms of intracranial hypotension and leakage of clear fluid surrounding the puncture site usually motivate referral to anaesthesia. Management strategies can be both conservative and invasive, including direct suture of the skin puncture site and epidural blood patch.

Regarding the anaesthesia practice on this topic, most of the available evidence is based on case reports, rendering the decision-making process challenging.

  • anaesthesia
  • pregnancy

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  • Contributors AIP performed literature research, wrote and managed the case. Is the guarantor. DLF performed literature research and revision. AA performed literature research and revision. SN indentified, managed and reviewed the case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.