Unintentional combined epidural and subdural block. Case report.
OBJECTIVE
Unintentional subdural block, while attempting an epidural anesthetic, is a rare but known complication. The authors describe a radiologically confirmed case of an unintentional combined epidural and subdural block while attempting to perform an epidural block for transurethral resection of prostate in a middle-aged man.


METHODS
Loss of resistance to air injection was used for identifying the epidural space prior to catheter placement. Following the epidural injection of 20 mL of a 1.5% lidocaine and 0.5% bupivacaine mixture, the patient developed rapid, intense, prolonged, and extensive bilateral motor block up to C2 level.


RESULTS
The patient had aphonia and respiratory paralysis requiring endotracheal intubation and controlled ventilation for 3 hours.


CONCLUSIONS
Postoperative radiologic examination revealed the spread of the dye in both epidural and subdural spaces, causing the extensive sensory and motor block.
Chauhan
S
S
Department of Anaesthesiology and Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Gaur
A
A
Tripathi
M
M
Kaushik
S
S
D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D002045:Bupivacaine / Q000009:adverse effects*; D006801:Humans; D007431:Intraoperative Complications; D008012:Lidocaine / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D011468:Prostatectomy; D012121:Respiration, Artificial; D012133:Respiratory Paralysis / Q000209:etiology / Q000628:therapy; D013355:Subdural Space
D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine