The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
권호 표지
DOI QR코드

DOI QR Code

Accidental Subdural Injection during Attempted Cervical Epidural Block: Radiologic Evidence -A case report-

경추부 경막외 차단 중 발생한 경막하 주사의 영상 소견 -증례보고-

  • Ko, Hyun Hak (Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University) ;
  • Kim, Ji Soo (Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University) ;
  • Lee, Jae Jun (Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University) ;
  • Hwang, Sung Mi (Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University) ;
  • Lim, So Young (Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University)
  • 고현학 (한림대학교 의과대학 마취통증의학교실) ;
  • 김지수 (한림대학교 의과대학 마취통증의학교실) ;
  • 이재준 (한림대학교 의과대학 마취통증의학교실) ;
  • 황성미 (한림대학교 의과대학 마취통증의학교실) ;
  • 임소영 (한림대학교 의과대학 마취통증의학교실)
  • Received : 2008.10.15
  • Accepted : 2008.11.21
  • Published : 2009.04.01
Download PDF
⟨ Previous Next ⟩

Abstract

Case reports after accidental subdural injection during attempted epidural block have usually described extensive neuraxial blocks with a characteristic radiographic appearance on contrast injection. We experienced a case of cervical subdural injection with unusual clinical findings and radiographic appearance. A 51-year-old female patient with central herniated nucleus pulposus at cervical (C5/6) and lumbar level (L4/5, L5/S1) was referred to the pain clinic. During attempted cervical epidural block at the C6/7 interspace with fluoroscopy, injection of the 4 ml contrast showed posterior spread at cervical level. After cervical epidural steroid injection, the contrast was also confined to the posterior aspect of the spinal canal at lumbar level with fluoroscopy. In order to discriminate subdural space from epidural space, we performed transforaminal epidural injection of the 2 ml contrast at the L5/S1 interspace and we could confirm cervical epidural injection was made into the subdural space. We discuss the clinical characteristics of a subdural injection and the appearance of the cervical and lumbar subdurogram.

Keywords

References

  1. Lubenow T, Keh-Wong E, Kristof K, Ivankovich O, Ivankovich AD: Inadvertent subdural injection: a complication of an epidural block. Anesth Analg 1988; 67: 175-9 https://doi.org/10.1213/00000539-198802001-00175
  2. Milants WP, Parizel PM, de Moor J, Tobback IG, De Schepper AM: Epidural and subdural contrast in myelography and CT myelography. Eur J Radiol 1993; 16: 147-50 https://doi.org/10.1016/0720-048X(93)90013-D
  3. Tarkkilla PJ: Incidence and causes of failed spinal anesthetics in a university hospital: a prospective study. Reg Anesth 1991; 16: 48-51
  4. Dawkins CJ: An analysis of the complications of extradural and caudal block. Anaesthesia 1969; 24: 554-63 https://doi.org/10.1111/j.1365-2044.1969.tb02909.x
  5. Collier CB: Accidental subdural block: four more cases and a radiographic review. Anaesth Intensive Care 1992; 20:215-25
  6. Cheun JK, Kim AR, Lee HR: Accidental subdural block developed during epidural anesthesia. Korean J Pain 1993; 6: 265-9
  7. Jung GS, Song SO, Cho YW: Accidental subdural steroid injection during intended epidural block relieves intractable radiculopathy in failed back surgery syndrome: a case report. Korean J Pain 2001; 14: 104-9
  8. Abouleish E, Goldstein M: Migration of an extradural catheter into the subdural space. A case report. Br J Anaesth 1986; 58: 1194-7 https://doi.org/10.1093/bja/58.10.1194
  9. Lim KI, Kim SH: Accidental subdural catheterization for epidural neurolysis with phenol. Korean J Pain 1998; 11:155-9
  10. Ischia S, Maffezzoli GF, Luzzani A, Pacini L: Subdural extra-arachnoid neurolytic block in cervical pain. Pain 1982;14: 347-54 https://doi.org/10.1016/0304-3959(82)90143-9
  11. Bansal S, Turtle MJ: Inadvertent subdural spread complicating cervical epidural steroid injection with local anaesthetic agent. Anaesth Intensive Care 2003; 31: 570-2
  12. Collier CB: Accidental subdural injection during attempted lumbar epidural block may present as a failed or inadequate block: radiographic evidence. Reg Anesth Pain Med 2004;29: 45-51 https://doi.org/10.1016/j.rapm.2003.10.012
  13. Collier CB, Gatt SP, Lockley SM: A continuous subdural block. Br J Anaesth 1993; 70: 462-5 https://doi.org/10.1093/bja/70.4.462
  14. Manchanda VN, Murad SH, Shilyansky G, Mehringer M: Unusual clinical course of accidental subdural local anesthetic injection. Anesth Analg 1983; 62: 1124-6
  15. Ajar AH, Rathmell JP, Mukherji SK: The subdural compartment. Reg Anesth Pain Med 2002; 27: 72-6 https://doi.org/10.1097/00115550-200201000-00013
  16. Mehta M, Salmon N: Extradural block. Confirmation of the injection site by X-ray monitoring. Anaesthesia 1985; 40:1009-12 https://doi.org/10.1111/j.1365-2044.1985.tb10558.x
  17. Miller DC, Choi WW, Chestnut DH: Subdural injection of local anesthetics and morphine: a complication of attempted epidural anesthesia. South Med J 1989; 82: 87-9
  18. Lehmann LJ, Pallares VS: Subdural injection of a local anesthetic with steroids: complication of epidural anesthesia. South Med J 1995; 88: 467-9 https://doi.org/10.1097/00007611-199504000-00018
  19. Reina MA, De Leon Casasola O, L$\acute{o}$pez A, De Andr$\acute{e}$s JA, Mora M, Fern$\acute{a}$ndez A: The origin of the spinal subdural space: ultrastructure findings. Anesth Analg 2002; 94:991-5 https://doi.org/10.1097/00000539-200204000-00040
  20. Rathmell JP, Song T, Torian D, Alsofrom GF: Lumbar epidurography. Reg Anesth Pain Med 2000; 25: 540-5 https://doi.org/10.1097/00115550-200009000-00018

Cited by

  1. Accidental intradural injection during attempted epidural block -A case report- vol.60, pp.3, 2011, https://doi.org/10.4097/kjae.2011.60.3.205
  2. Optimal volume of injectate for fluoroscopy-guided cervical interlaminar epidural injection in patients with neck and upper extremity pain vol.95, pp.43, 2016, https://doi.org/10.1097/MD.0000000000005206
  3. An Unusual Delayed Onset of Systemic Toxicity After Fluoroscopy‐Guided Cervical Epidural Steroid Injection With Levobupivacaine: A Case Report vol.19, pp.7, 2009, https://doi.org/10.1111/papr.12802