title: Epidural spread after continuous cervical paravertebral block: a case report.
abstract: OBJECTIVE
  This report illustrates epidural spread after continuous cervical paravertebral block (CCPVB). By fluoroscopy, it also explains the mechanism of the complication.
  
  
  METHODS
  A healthy 22-year-old male developed bilateral upper-extremity motor weakness immediately after placement of a continuous cervical paravertebral block for postoperative pain control after shoulder stabilization surgery. The tip of the stimulating catheter was demonstrated in the C7 neuroforamen. Contrast injected through the catheter demonstrated epidural spread. The contralateral block resolved after 4 hours and the patient suffered no respiratory embarrassment or other untoward sequelae.
  
  
  CONCLUSIONS
  Continuous cervical paravertebral block is a relatively new, but generally well-accepted, modality for postoperative pain control after major surgery to the upper limb. Epidural spread is recognized as a complication. In this particular case, medial placement of the catheter was possibly caused by unintentional medial direction of the bevel of the Tuohy needle. Meticulous attention to the direction of the needle bevel and early recognition and management of adverse events are mandatory. The same principles may apply for continuous thoracic, lumbar, and sacral paravertebral blocks.
authors.affiliation: Regional Anesthesia Study Center of Iowa, Department of Anesthesia, University of Iowa, Iowa City, IA 52242, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Frohm
authors.forename: Robert M
authors.initials: RM
authors.lastname: Raw
authors.forename: Naeem
authors.initials: N
authors.lastname: Haider
authors.forename: André P
authors.initials: AP
authors.lastname: Boezaart
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000378:metabolism* / Q000627:therapeutic use; D004824:Epidural Space / Q000378:metabolism*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000378:metabolism* / Q000627:therapeutic use; D008297:Male; D009407:Nerve Block; D010149:Postoperative Pain / Q000517:prevention & control*; D012782:Shoulder / Q000601:surgery*
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine