Epidural spread after continuous cervical paravertebral block: a case report.
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Epidural spread after continuous cervical paravertebral block: a case report.
Reg Anesth Pain Med. 2006 May-Jun;31(3):279-81
Authors: Frohm RM, Raw RM, Haider N, Boezaart AP
BACKGROUND AND OBJECTIVE: This report illustrates epidural spread after continuous cervical paravertebral block (CCPVB). By fluoroscopy, it also explains the mechanism of the complication. CASE REPORT: A healthy 22-year-old male developed bilateral upper-extremity motor weakness immediately after placement of a continuous cervical paravertebral block for postoperative pain control after shoulder stabilization surgery. The tip of the stimulating catheter was demonstrated in the C7 neuroforamen. Contrast injected through the catheter demonstrated epidural spread. The contralateral block resolved after 4 hours and the patient suffered no respiratory embarrassment or other untoward sequelae. CONCLUSION: Continuous cervical paravertebral block is a relatively new, but generally well-accepted, modality for postoperative pain control after major surgery to the upper limb. Epidural spread is recognized as a complication. In this particular case, medial placement of the catheter was possibly caused by unintentional medial direction of the bevel of the Tuohy needle. Meticulous attention to the direction of the needle bevel and early recognition and management of adverse events are mandatory. The same principles may apply for continuous thoracic, lumbar, and sacral paravertebral blocks.
PMID: 16701196 [PubMed - indexed for MEDLINE]
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Last week we did US guided thoracic paravertebral and deliberately turned the bevel medially(we place those just a touch lateraly then the junction of TP and the rib so we can have clear view of the needle and the spread…so I thought that with bevel turned medially if one does not advance catheter too far( 3 cm) we will have better chance for more central position and better spread. Block worked great but one catheter end up close to neuroforamina and we had definite epidural spread with bilateral block and blood pressure drop with initial bolus. We did not do fluoro just dropped the rate on this particular catheter and patient did great( bilateral block resolved, no pressure issues…) One can actually see paravertebral cath on regular X-ray and make an educated guess regarding the tip position. The teaching point is: 1.watch your bevel direction, 2.do not advance cath too far and 3. please resist temptation to skip gradual 5 ml at a time bolus practice for any paravertebral.
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