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Temporary quadriplegia following continuous thoracic paravertebral block
Emile Calenda1, Jean Marc Baste, Eric Danielou
1Service d'Anesthésie et Réanimation Chirurgicale, Rouen University Hospital, Hôpital Charles-Nicolle, 1 rue de Germont, 76031, Rouen Cedex, France. emile.calenda@chu-rouen.fr
Journal of Clinical Anesthesia
|April 10, 2012
Summary
A case report details temporary quadriplegia in an adult after a continuous thoracic paravertebral block. The complication arose due to intrathecal catheter placement, highlighting the need for precise localization during the procedure.
Area of Science:
- Anesthesiology
- Neurosurgery
- Thoracic Surgery
Background:
- Continuous thoracic paravertebral block is a regional anesthesia technique for thoracic procedures.
- Accurate catheter placement is crucial to prevent neurological complications.
- Video-assisted thoracoscopy requires effective postoperative pain management.
Observation:
- A case involving an adult patient undergoing video-assisted thoracoscopy.
- An 18-gauge Tuohy needle was used for thoracic paravertebral block insertion.
- The catheter tip was not localized during the procedure.
Findings:
- The patient experienced temporary quadriplegia 90 minutes after initiating a ropivacaine infusion.
- Postoperative imaging revealed the epidural catheter was unintentionally placed in the intrathecal space.
- This resulted in unintended high-level neuraxial blockade.
Implications:
- Intrathecal catheterization can lead to severe neurological deficits, including paralysis.
- Emphasizes the critical importance of catheter tip localization techniques in regional anesthesia.
- Highlights the potential for serious adverse events with thoracic paravertebral blocks if not performed meticulously.
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