title: Spinal injection of local anesthetic during cervical facet joint injection.
abstract: BACKGROUND
  Facet joint pain is a common source of non-radicular back pain worldwide. Non-surgical interventional modalities remain the mainstay in the treatment of facetogenic back pain and comprise the second most commonly performed interventional pain procedures in the USA.
  
  
  METHODS
  A 36 year-old man with chronic cervical pain secondary to C6-C7 facet arthrosis radiographically, underwent diagnostic local anesthetic bilateral facet joint injection under fluoroscopic guidance. The left side was injected uneventfully; however, 1-2min following injection of the right side the patient complained of unwellness and became very anxious. He referred paresthesias of the bilateral upper extremities, chest and upper abdomen. Physical examination showed sensory deficits roughly from C5 to T7 without motor deficits; resuscitation measures were not warranted. The deficits were completely resolved by 35-40min in the recovery area.
  
  
  CONCLUSIONS
  Facet joint injections are a common and safe method of treating back pain secondary to facet arthropathy. Despite excellent safety profiles, rare and sometimes, life-threatening complications can occur. Our case hypothesizes intrathecal injection of local anesthetic during facet joint injection. Few reports have described similar situations. We hypothesize a mechanism of entry through the facet joint, given the proximity of the ligamentum flavum, and the intrathecal space to the anterior aspect of the facet joint. This report reinforces the need for resuscitation and airway management equipment to be readily available where interventional procedures are performed, as well as the need for adequate proficiency in airway management and resuscitation techniques in Pain Medicine training.
authors: Universidade de Carabobo, Departamento de Anestesiología, Valencia, Venezuela. Electronic address: juan_ramos66@hotmail.com.
authors: Juan A
authors: JA
authors: Ramos
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D001416:Back Pain / Q000150:complications / Q000188:drug therapy; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007270:Injections, Intra-Articular / Q000009:adverse effects; D007278:Injections, Spinal; D008297:Male; D019300:Medical Errors; D013122:Spinal Diseases / Q000139:chemically induced*; D021801:Zygapophyseal Joint
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine
keywords: Articulações zigoapofisárias; Controle da dor; Injections; Injeções; Intra-articular; Pain management; Zygapophyseal joint