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Accidental total spinal block: A complication of an epidural test dose

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Abstract

A case is presented of a 36-yr-old parturient who developed a total spinal block after an epidural test dose. After placement of an epidural catheter and confirming negative aspiration for blood or CSF, 3 ml lidocaine 1.5% (45 mg), with 1:200,000 epinephrine (15 μg) was injected via the catheter over 30 sec. Within two minutes the patient developed hypotension and extensive sensory and motor block including respiratory paralysis and aphonia. She remained fully conscious and alert and spontaneous respiration recommenced in five minutes. A live healthy infant was delivered by emergency Caesarean section shortly afterwards under general anaesthesia and the mother recovered completely without any untoward sequelae.

Résumé

On présente ici l’observation d’une parturiente de 36 ans qui subit un bloc rachidien total après une dose-test épidurale. Après l’insertion du cathéter épidural et la confirmation de son positionnement par un test négatif d’aspiration de sang et de LCR, 3 ml de lidocaïne 1,5%, (45 mg) avec épinéphrine 1:200,000 (15 μg) sont injectés par le cathéter sur une période de 30 secondes. En moins de deux minutes, la patiente développe de l’hypotension associée à un bloc sensitif et moteur étendu avec paralysie respiratoire et aphonie. Elle demeure pleinement consciente et sa respiration reprend en cinq minutes. Un enfant en bonne santé naît par césarienne d’urgence sous anesthésie générale et la mère récupère complètement sans séquelles.

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Correspondence to Neelkanth V. Palkar.

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Palkar, N.V., Boudreaux, R.C. & Mankad, A.V. Accidental total spinal block: A complication of an epidural test dose. Can J Anaesth 39, 1058–1060 (1992). https://doi.org/10.1007/BF03008375

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Key words

  • anaesthetic techniques: regional, epidural
  • anaesthesia: obstetric
  • complications: total spinal