title: Unintended epidural placement of a thoracic paravertebral catheter in a patient with severe chest trauma.
abstract: OBJECTIVE
  Severe pain can lead to ventilatory compromise in patients with multiple rib fractures. Regional anesthetic techniques, including continuous thoracic paravertebral and thoracic epidural blocks, can be useful in reducing this pain and subsequent morbidity due to respiratory compromise. Thoracic paravertebral block can result in significant complications. Presumed epidural spread of injected medication has been described with thoracic paravertebral block. High-quality radiographic images of an attempted placement of a thoracic paravertebral catheter in the epidural space have not been reported. We present these images to highlight the occurrence of this complication.
  
  
  METHODS
  In this case, we report an attempted placement of a thoracic paravertebral catheter that passed into the epidural space. High-fidelity, three-dimensional computer tomography images and the management of the unintended epidural catheterization are presented.
  
  
  CONCLUSIONS
  In the setting of severe chest trauma, the potential risk of unintended placement of an intended thoracic paravertebral catheter in the epidural space is graphically illustrated as a potential risk of this procedure.
authors.affiliation: Department of Anesthesiology, Division of Regional Anesthesiology and Perioperative Pain Medicine, University of Florida College of Medicine, Gainesville, Florida 32610-0254, USA. slucas@anest.ufl.edu
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Lucas
authors.forename: Travis
authors.initials: T
authors.lastname: Higdon
authors.forename: André P
authors.initials: AP
authors.lastname: Boezaart
mesh_terms: D002404:Catheterization / Q000009:adverse effects* / Q000379:methods; D057785:Catheters / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D013898:Thoracic Injuries / Q000150:complications*; D014057:Tomography, X-Ray Computed