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Subdural block--from a spinal? A case report.

S Y Chan1, E L Ong

  • 1Department of Anaesthesia, Changi General Hospital, 2 Simei Street 3, Singapore 529889.

Annals of the Academy of Medicine, Singapore
|August 7, 2002
PubMed
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A rare subdural block presentation occurred after a spinal anesthetic in an obese patient. This case highlights unusual block spread and the need for considering subdural block in atypical spinal anesthesia cases.

Area of Science:

  • Anesthesiology
  • Neurosurgery

Background:

  • Multicompartmental blocks are frequently observed in epidural anesthesia but rarely documented in spinal anesthesia.
  • This case report details an unusual presentation following a subarachnoid block in an obese patient, mimicking a subdural block.

Observation:

  • A 29-year-old obese female received 2.1 mL of hyperbaric bupivacaine for a spinal anesthetic.
  • The patient experienced a delayed onset of sensory blockade extending to the neck and upper extremities.
  • Notably, there was an absence of sympathetic or motor blockade.

Findings:

  • The spinal block resolved spontaneously without any adverse cardiovascular or respiratory effects.
  • The clinical presentation suggested a subdural block, despite the intended subarachnoid administration.

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Implications:

  • Clinicians should consider the possibility of a subdural block in patients presenting with atypical symptoms after spinal anesthesia.
  • Understanding the factors influencing the spread of hyperbaric bupivacaine is crucial for managing unexpected block characteristics.