Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2004
Case ReportsAccidental subdural injection during attempted lumbar epidural block may present as a failed or inadequate block: radiographic evidence.
Until now, case reports after accidental subdural injection during attempted epidural block have usually described extensive neuraxial blocks with a delayed onset, after low doses of local anesthetic, with a characteristic radiographic appearance on contrast injection. Our radiographic investigation of atypical "epidural" blocks has revealed that subdural injection may go unrecognized clinically and may be a cause of inadequate blocks. The mechanism is explored. ⋯ Accidental subdural injection may now be added to the list of causes of failed or inadequate "epidural" block. Clinicians should be aware of the diagnosis of a possible subdural injection, if a poor quality block with restricted spread and slow onset is associated with pain on postoperative reinjection of the catheter.
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Reg Anesth Pain Med · Jan 2004
Editorial CommentRestricting spinal block to the operative side: why not?