title: Unintentional subdural block during labor epidural in a parturient with prior Harrington rod insertion for scoliosis. Case report.
abstract: OBJECTIVE
  The authors report a case of unintentional subdural block in a parturient with prior Harrington rod insertion.
  
  
  METHODS
  The epidural technique was performed successfully at the L5-S1 interspace using the loss-of-resistance technique after two failed attempts at the L3-4 interspace.
  
  
  RESULTS
  Twenty to 30 minutes after total initial dose of 9 mL 0.25% bupivacaine with 1/200,000 epinephrine, the patient developed hypotension and a high sensory block involving the trigeminal nerve. The patient also complained of difficulties in swallowing and breathing. Signs and symptoms strongly suggested an unintentional subdural block. After careful monitoring and reassurance, the patient's sensory level receded and she could breathe and swallow comfortably. Intubation was not required. The epidural catheter was maintained in the same space. The amount of 0.25% bupivacaine was reduced to 2 mL for subsequent top-ups. Adequate analgesia was provided throughout the course of her labor and delivery without other complications.
  
  
  CONCLUSIONS
  Lumbar epidural anesthesia is not always an easily performed technique and is known to be associated with a higher incidence of complications in patients with prior Harrington rod insertion. Prompt recognition and proper management of subdurally placed needle and catheter avoided more serious complications.
authors.affiliation: Department of Anesthesiology, Jackson Memorial Hospital, Miami, Florida 33136, USA.
authors.forename: Y S
authors.initials: YS
authors.lastname: Lee
authors.forename: R H
authors.initials: RH
authors.lastname: Bundschu
authors.forename: E C
authors.initials: EC
authors.lastname: Moffat
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D001858:Bone Nails; D005260:Female; D006801:Humans; D011247:Pregnancy; D012600:Scoliosis / Q000150:complications*; D013355:Subdural Space