Inadvertent brainstem anesthesia following extraoral trigeminal V2-V3 blocks

Total brainstem anesthesia with respiratory arrest followed extraoral trigeminal V2-V3 diagnostic nerve blocks for trigeminal neuralgia using a combination of 0.25 percent Bupivacaine, Sarapin, and triamcinolone. While an untoward reaction to either the Sarapin or triamcinolone cannot be ruled out, the most probable cause for this problem was the inadvertent intrathecal injection of Bupivacaine since the reaction can be explained on the basis of a local anesthetic effect. No such effect has been attributed to either of the other components of the mixture. Proper monitoring and prompt attention permitted attenuation of this potentially life-threatening complication.