Delayed bilateral spinal anaesthesia following interscalene brachial plexus block

Area of Science:

• Anesthesiology
• Neurology

Background:

• Interscalene brachial plexus block is a common regional anesthesia technique.
• Complications, though rare, can include neuraxial blockade.
• Delayed onset of neuraxial blockade is an unusual presentation.

Observation:

• A 65-year-old patient developed bilateral neuraxial blockade 65 minutes after an interscalene block for radial head excision.
• The block progressed to involve cervical to lumbar dermatomes, sparing phrenic nerves.
• The patient remained alert and hemodynamically stable throughout the event.

Findings:

• This case demonstrates a delayed, bilateral neuraxial blockade following an interscalene block.
• The presumed mechanism involves dural cuff puncture and slow cerebrospinal fluid (CSF) spread from a local anesthetic depot.
• The patient also experienced a post-dural puncture headache responding to conservative treatment.

Implications:

• Highlights the potential for delayed central neural blockade after interscalene blocks.
• Suggests a need for vigilance in monitoring patients post-block, even with delayed onset.
• The proposed mechanism offers insight into the pathophysiology of such rare complications.