Extensive extradural pneumorrhachis related to obstetric analgesia

Iatrogenic extradural pneumorrhachis is a rare clinical entity, but anesthesiologists should be aware of this possibility when using the air technique for the identification of epidural space. Although in most published cases extradural pneumorrhachis is asymptomatic, relevant neurological consequences have been described, such as meningeal irritation, radicular pain, unilateral lower extremity weakness, cauda equina syndrome, paraplegia, and tetraplegia. We describe a very extensive extradural pneumorrachisis (T9 -S1), related to obstetric analgesia, in a patient with severe and atypical perineal pain after forceps-assisted delivery. Our aim is to synthesize and organize the available scientific evidence, analyzing preventive measures and summarizing the most appropriate diagnostic, follow-up and therapeutic techniques for symp- tomatic conditions, among which high concentrations of inspired oxygen, hyperbaric oxygen therapy and percutaneous or surgical decompression have been described. (c) 2023 Sociedad Espanola de Anestesiolog & iacute;a, Reanimaci & oacute;n y Terap & eacute;utica del Dolor. Published by Elsevier Espana, S.L.U. All rights reserved.