Total Spinal Block after Thoracic Paravertebral Block

Area of Science:

• Anesthesiology
• Neurology

Background:

• Thoracic paravertebral block (TPVB) is a regional anesthesia technique utilized for various surgical procedures, known for its favorable side effect profile and potent analgesia.
• TPVB can be administered with or without general anesthesia, offering flexibility in surgical management.

Observation:

• A 63-year-old patient with comorbidities undergoing cholecystectomy received a unilateral TPVB at T7 using 20 mL of 0.5% levobupivacaine and a neurostimulator.
• Following the TPVB, the patient experienced loss of consciousness and required intubation, with subsequent hemodynamic instability managed by volume replacement and vasopressors.

Findings:

• The patient developed a total spinal block, a rare but life-threatening complication characterized by hypotension, bradycardia, apnea, and cardiac arrest.
• Spontaneous breathing and consciousness returned approximately three hours after the TPVB, following cessation of anesthetic drugs and antagonism of muscle relaxants.

Implications:

• This case highlights the potential for total spinal block as a complication of TPVB, emphasizing the need for vigilance and prompt recognition.
• Early diagnosis and appropriate management are crucial for improving patient outcomes in cases of total spinal block following peripheral nerve blocks.