Inadvertent subdural spread complicating cervical epidural steroid injection with local anaesthetic agent.
Although cervical epidural steroid injection with local anaesthetic is considered a safe technique and widely practiced, complications may occur. We report a patient experiencing unexpected delayed high block, moderate hypotension and unconsciousness eight to ten minutes after an apparently normal cervical epidural steroid injection. The most probable diagnosis was a subdural block. Anatomical peculiarities of the epidural and subdural space in the cervical region increase the risk of subdural spread during cervical epidural injection. Fluoroscopic guidance is important during cervical epidural injection to increase certainty of correct needle placement, thus minimizing the risk of complications.
Anaesthetic Department, Walsgrave Hospital, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, United Kingdom.
S
S
Bansal
M J
MJ
Turtle
D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000379:methods; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000009:adverse effects*; D008875:Middle Aged; D018908:Muscle Weakness / Q000139:chemically induced; D009407:Nerve Block; D012119:Respiration / Q000187:drug effects; D013128:Spinal Osteophytosis / Q000188:drug therapy; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects*; D013355:Subdural Space / Q000187:drug effects; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000009:adverse effects; D014474:Unconsciousness / Q000139:chemically induced
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D013256:Steroids; D014222:Triamcinolone Acetonide; D002045:Bupivacaine