Hyperbaric Therapy for a Postpartum Patient with Prolonged Epidural Blockade and Tomographic Evidence of Epidural Air

We used the epidural technique "loss of resistance to air" to provide labor analgesia in a healthy parturient. Inadequate analgesia required epidural catheter replacement using the same technique. Delayed recovery of sensory and motor blockade postpartum necessitated computed tomography and magnetic resonance imaging studies. These revealed 4-6 mL of air in the epidural space with no evidence of thecal compression. On the advice of the neurologist, this patient underwent hyperbaric therapy 14 h after the discontinuation of the epidural infusion. The patient made a complete recovery and was discharged without neurologic sequelae. It is possible that epidural air delayed the absorption of local anesthetics as a result of a reduction in the vascular surface area. Although a cause and effect relationship between epidural air and prolonged neurological block cannot be categorically established, the use of "loss of resistance to air" technique complicated the differential diagnosis.