Subarachnoid injection during retrobulbar block: a case report

Subarachnoid injection during a retrobulbar block is a rare complication, requiring prompt recognition and management of life-threatening respiratory and cardiac depression. This case report describes a patient who began to decompensate 2 minutes after receiving a retrobulbar block. Central nervous system symptoms progressed from restlessness and confusion to respiratory arrest and cardiac depression. Intubation, ventilatory support, and treatment of mild bradycardia and hypotension were provided. One hour after the incident, the patient was fully awake and was extubated. Brain stem anesthesia was suspected. Causes of respiratory arrest and unconsciousness after retrobulbar block include severe anaphylactic reaction, intravascular absorption, a major cardiovascular event, and subarachnoid injection of local anesthetic. The patient's symptoms in the case presented here suggested that the local anesthetic gained access to the cerebrospinal fluid. Anesthetists should be cognizant of the need to monitor and treat serious complications whenever a retrobulbar block is utilized.