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Unintentional combined epidural and subdural block. Case report
S Chauhan1, A Gaur, M Tripathi
1Department of Anaesthesiology and Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Regional Anesthesia
|May 1, 1995
Summary
Anesthesia complication: A rare combined epidural and subdural block occurred during a prostate surgery epidural anesthetic attempt. This resulted in extensive motor block and respiratory paralysis, requiring mechanical ventilation.
Area of Science:
- Anesthesiology
- Neurosurgery
- Radiology
Background:
- Unintentional subdural block is a rare complication during epidural anesthesia attempts.
- This case highlights a combined epidural and subdural block during a transurethral resection of the prostate (TURP).
Observation:
- A middle-aged male patient received an epidural anesthetic for TURP.
- Loss of resistance technique was used to identify the epidural space.
- A mixture of lidocaine and bupivacaine was injected epidurally.
Findings:
- The patient experienced rapid, intense, and prolonged bilateral motor block extending to the C2 level.
- Aphonia and respiratory paralysis necessitated endotracheal intubation and mechanical ventilation for 3 hours.
- Postoperative imaging confirmed dye spread into both epidural and subdural spaces.
Implications:
- This case underscores the importance of recognizing and managing unintentional subdural injections during epidural procedures.
- Radiological confirmation is crucial for diagnosing combined epidural and subdural blocks.
- Awareness of this complication can improve patient safety and anesthetic management.