[Epidural malpositioning of an interscalene plexus catheter]

A patient received an interscalene plexus catheter before shoulder surgery. After induction of general anesthesia catheter placement was performed with Winnie's technique and 5 ml of ropivacaine was injected via the catheter. In the recovery room slight dyspnea without wheezing was observed which improved spontaneously. Following another bolus of ropivacaine, dyspnea and paralysis of the contralateral arm developed and the patient became hypotensive. The tomography scan showed epidural malpositioning of the catheter. Neuraxial complications of interscalene regional anesthesia are especially possible with medially directed insertion of the needle and have been described many times in the literature. The symptoms and recommendations for prevention are discussed.