Meningitis following a combined spinal epidural technique in a labouring term parturient

Purpose: To report a case of probable bacterial meningitis in a parturient who received a combined spinal-epidural (CSE) technique for labour analgesia. Clinical Features: A 28-yr-old GIP0 at 40 wk gestational age presented in labour and requested analgesia. A CSE technique was used to inject a mixture of fentanyl 25 mu g and bupivacaine 2.5 mg into the subarachnoid space following which a catheter was inserted into the epidural space. Sixteen hours after delivery her body temperature increased to 38.7 degrees C and she complained of a non-positional frontal headache. This was associated with chills photophobia, and mild nuchal rigidity. Diagnostic lumbar puncture revealed cloudy cerebrospinal fluid (CSF) with increased polymorphonuclear (PMN) white cell count and increased protein and decreased glucose concentrations. Peripheral blood cytology also showed an increased leukocyte count with a shift to the left. Immediate treatment with antibiotics was instituted and the patient rapidly recovered without sequelae. Conclusions: Meningitis may occur, albeit rarely, with any neuraxial blocks including CSE techniques. Early diagnosis and appropriate antibiotic therapy are important in preventing serious neurological sequelae.