Unexpectedly high block following epidural catheter placement under direct vision: a case report

A 72-year-old female underwent elective lumbar spinal decompression. At the end of the procedure an epidural catheter was sited by the surgeon under direct vision. A bolus of levobupivacaine was injected. Shortly after reaching the recovery area, the patient collapsed and required re-intubation and mechanical ventilation. She was extubated five hours later and suffered no adverse sequelae. Having excluded other possible causes of immediate post-operative collapse, a clinical diagnosis of subdural blockade was made. A literature search using Medline has found no other case reports of such a complication following epidural placement under direct vision.