Pneumorrhachis complicating acute pain management using a thoracic epidural catheter

The use of thoracic epidural catheters to infuse local anaesthetics and opioids is a common practice in acute pain management to attenuate the pain associated with thoracic and abdominal surgical procedures. The placement and maintenance of epidural analgesia is known to be associated with a variety of potential complications. A rare complication is the development of air of within the spinal canal (pneumorrhachis). Although pneumorrhachis is typically asymptomatic and resolves spontaneously, it rarely can be associated with neurological dysfunction. Here we describea case of pneumorrhachis that led to symptomatic acute spinal cord compression in a 27 year old man who had a thoracic epidural placed to help with pain management following laparotomy for the management of Crohn’sdisease. Postoperatively, the patient developed unilateral weakness in his upper and lower extremities and sensory dysfunction in the upper extremity. Urgent neuroimaging demonstrated epidural air causing mass effect on the cervical spinal cord. His symptoms resolved completely following conservative management. This rare presentation of pneumorrhachis highlights the need for close vigilance regarding neurological function in patients with epidural catheters for acute pain management. This presentation also promotes mitigation of factors that may be associated withthe administration of air into the epidural space, such as changing epidural infusion solution bags and malfunction of epidural infusion pumps.