Reactions 1183 - 5 Jan 2008

Fentanyl/ropivacaine

Accidental subdural block following epiduralanaesthesia in an elderly patient: a case report

A 76-year-old man developed accidental subdural block,following administration of fentanyl and ropivacaine [dosagesnot stated] as patient-controlled anaesthesia prior to a totalgastrectomy.

A 10cm multi-hole catheter was inserted into the epiduralspace of the man’s lumbar region at L2 and L3. Opioidanalgesics and a local anaesthetic were then administeredwithout complication. When he awoke he was agitated and insevere pain. He was supplied with patient-controlledanalgesia, consisting of fentanyl 1 µg/mL and 0.1%ropivacaine. Two hours and 30 minutes later, he experiencedbilateral motor block from L1 to L5, and sensory blockade atT12.

The man’s patient-controlled analgesia was discontinued.He underwent a lumbar CT using a contrast medium, in orderto find the subdural position of the catheter. The catheter wasremoved and he was supplied with intravenous patient-controlled analgesia. Three hours later the motor block hadcompletely resolved. He experienced no further neurologicalproblems and was discharged home.

Author comment: "Placing a longer length of catheter inthe epidural space increases the risk that it will enter anepidural vein, puncture the spinal meninges, exit anintervertebral foramen, wrap around a nerve root, or wind upin some other disadvantageous location. The clinicalpresentation of this subdural block. . .could be explained bythe anterior position of the catheter."Pereira SG, et al. Subdural accidental blockage: clinical evaluation andimagiological study. Regional Anesthesia and Pain Medicine 32 (Spec. issue 1): 38abstr. 71, No. 5, Sep-Oct 2007 [abstract] - Portugal 801095018

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Reactions 5 Jan 2008 No. 11830114-9954/10/1183-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved