Stellate ganglion block can be effective for neuropathic pain with sympathetically dependent pain in the orofacial area. A paratracheal approach for stellate ganglion block has been recommended as the safest route because of its technical simplicity. We herein report a rare complication of total spinal anesthesia following the inadvertent subarachnoid injection of a local anesthetic during a stellate ganglion block.
A-55-year old female received stellate ganglion blocks for the relief of neuropathic pain in the right lower molar area. Immediately after the sixth stellate ganglion block with 6 ml of 1% lidocaine, the patient suddenly lost consciousness and her breathing stopped completely. We soon initiated cardiopulmonary resuscitation using a bag valve mask connected to an oxygen tank. Her electrocardiogram (ECG) was normal, with a heart rate of 62 beats/min, a blood pressure of 140/84 mmHg, and a pulse oximetry of 74%. The pulse oximetry value quickly recovered to 99%. Approximately 10 minutes later, the patient was able to open her eyes slowly when her name was called. Spontaneous respiration appeared, and her consciousness had nearly recovered 13 minutes later. Approximately 90 minutes later, her general condition had almost recovered. She did not complain of a headache.
The clinical findings strongly suggested the occurrence of total spinal anesthesia following the inadvertent subarachnoid injection of lidocaine. The possible cause of the spread of the local anesthetic into the subarachnoid space is discussed in the present report. This case suggests that the preparation of a CPR kit should be required when performing stellate ganglion block treatment.
