2018 Volume 25 Issue 1 Pages 28-31
The subdural injection of local anesthetic is a rare complication of epidural injections. A 75-year-old female patient presented with right side cervical pain radiating into the right upper extremity. She received a fluoroscopy-guided right T1 transforaminal epidural injection. When the contrast medium was injected, it showed the right side T1 dorsal root ganglion. After injection of a local anesthetic, the patient complained of numbness of the right upper extremity. Numbness and motor weakness gradually extended to both arms and both legs. After ten minutes, she experienced respiratory difficulty. Moderate hypotension and bradycardia occurred, but her mental state was unaffected. Her symptoms resolved within two hours. She was discharged from our hospital the next day without experiencing any adverse events, including an orthostatic headache. The subdural space is a narrow space between the dura mater and the arachnoid membrane. The injection of local anesthetics into this space induced widespread neural blockage. Interventional pain physicians must have adequate knowledge of normal and abnormal patterns of epidural contrast dispersion.
