title: Inadvertent extra-arachnoid (subdural) injection of a local anaesthetic agent during epidural anaesthesia. A case report.
abstract: Profound hypotension occurring in a patient 2 hours after initiation of combined general and epidural anaesthesia for a myocutaneous free-flap graft was found to be attributable to subdural/extra-arachnoid injection of 0.5% bupivacaine. The initial diagnosis was based on a negative aspiration test, a delayed widespread sensory and sympathetic block, and the absence of any other obvious cause for the hypotension. This was confirmed by myelography, which demonstrated an extension of the contrast medium predominantly posteriorly in the spinal canal with excessive spread along the nerve roots. Posture and coughing did not affect the spread.
authors.affiliation: Department of Anaesthesia, Johannesburg Hospital.
authors.forename: A P
authors.initials: AP
authors.lastname: Boezaart
authors.forename: V S
authors.initials: VS
authors.lastname: Kadieva
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D002045:Bupivacaine / Q000008:administration & dosage*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007049:Iatrogenic Disease; D007268:Injections, Epidural / Q000009:adverse effects*; D008297:Male; D013355:Subdural Space
chemical_list: D002045:Bupivacaine