Epidural anaesthesia as a complication of attempted brachial plexus blockade using the posterior approach

We report a case of accidental epidural anaesthesia as a complication of attempted brachial plexus blockade using a posterior approach in a 31-year-old man scheduled to undergo elective shoulder surgery. The block was inserted with the patient in the lateral position before induction of general anaesthesia. On emergence from anaesthesia, the patient could breathe but could not move his arms. He had no pain sensation from the fifth cervical dermatome to the third thoracic dermatome bilaterally; this resolved 8 h after surgery and he was discharged well 2 days later. Although proponents of the posterior approach to the brachial plexus claim that its use is associated with a lower incidence of significant complications, this case proves that the technique is not devoid of potentially serious complications.