Reactions 1111 - 22 Jul 2006

Ropivacaine

Neurological disorders associated with epiduralspread following continuous cervical paravertebralblock: case report

Bilateral upper extremity motor weakness occurred in a22-year-old man following continuous cervical paravertebralblock (CCPVB) with ropivacaine for postoperative pain controlafter right shoulder stabilisation surgery. Epidural spread waslater demonstrated.

For CCPVB placement, the needle entry point was betweenC6 and the suprasternal notch, with the needle directedanteriorly and caudally toward the suprasternal notch untilcontact with the pars intervertebralis or articular C6 columnwas made. After needle placement, 30mL of ropivacaine 0.75%was injected incrementally via the catheter achieving asuccessful motor block in the right arm. Approximately5 minutes after completion of the injection, the man notednumbness in both hands. General anaesthesia was theninduced and surgery proceeded uneventfully. After emergencefrom general anaesthesia, he had only minimal bicep functionwith greatly reduced sensory function in his left arm.Fluoroscopic studies revealed that the catheter was lying withits tip at the neuroforamen of C7, with epidural spread from C4to T4.

Normal saline was injected and the epidural spreadincreased. Fifteen minutes later, the motor function in theman’s left arm was intact, but sensation in that arm remainedreduced. He also noted numbness over his chest area from themid-sternum to the root of the neck. The catheter wasremoved and he recovered uneventfully. At follow-up 2 weekslater, his neurological function was intact.

Author comment: "With the catheter tip lying in the C7neuroforamen, even small volumes of injectate can result inepidural spread."Frohm RM, et al. Epidural spread after continuous cervical paravertebral block: acase report. Regional Anesthesia and Pain Medicine 31: 279-281, No. 3, May-Jun2006 - USA 801066942

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Reactions 22 Jul 2006 No. 11110114-9954/10/1111-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved