Is continuous spinal analgesia via an epidural catheter appropriate after accidental subarachnoid administration of 15 mL of bupivacaine 0.1% containing fentanyl 2 micrograms/mL?
We report a case of accidental insertion of an epidural catheter into the subarachnoid space and accidental administration of 15 mL of bupivacaine 0.1% with fentanyl 2 micrograms/mL, in the sitting position, during labour. Within 5 min, the patient was unable to move her lower limbs. Although the upper level of the sensory block using ethyl chloride was found to be T5, there was no cardiovascular depression. The catheter was left in situ and used for continuous spinal analgesia. Further administration of the bupivacaine-fentanyl solution was not required until after 315 min. The patient was given five further 2- to 3-mL top-up doses of bupivacaine-fentanyl at intervals of 105 to 145 min. After 16 h, caesarean section was performed for failure to progress in the first stage of labour. This was conducted under spinal anaesthesia using 2 mL of hyperbaric bupivacaine 0.5% with fentanyl 20 micrograms. A healthy baby was delivered with Apgar scores of 10 and 10, at 1 and 5 min, respectively. There was no postdural puncture headache or any neurological complications.
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University Department of Anaesthesia, Critical Care and Pain Management, Leicester Royal Infirmary, Leicester, UK. anae@le.ac.uk
Shah
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Smith
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D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D000775:Anesthesia, Spinal; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D002404:Catheterization; D002585:Cesarean Section; D004824:Epidural Space; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D019300:Medical Errors; D007744:Obstetric Labor Complications / Q000139:chemically induced; D011247:Pregnancy; D013346:Subarachnoid Space
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine