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Foreign bodies in the epidural space lead to fibrous deposits. Spinal cord stimulation, when those deposits form a sheath, the sheath is useful for lead revision. The procedure, if meticulously performed, has a high success rate.

SummaryA case is reported of suspected inadvertent subdural block following attempted stellate ganglion blockade for relief of cervicobrachial pain in a patient suffering from reflex symparhetic dystrophy. Possible complications due to neuraxial spread of local anaesthetics while performing a cervicothoracic ganglion blockade are considered. Key wordsAnaesthetic techniques, regional; stellate ganglion block. Complications.Blockade of the stellate ganglion has been used for a wide variety of conditions. It is known to produce excellent relief from chronic pain in reflex sympathetic dystrophy (RSD), a pain syndrome mediated by sympathetic pathways.' Moore described 16 possible approaches to the stellate ganglion2 but the anterior paratracheal approach at the C, level, described by Lofstrom' and Carron and Litwiller4 is most commonly used because it has the advantage of placing the needle well above the dome of the pleura and anterior to the plane of the roots of the brachial plexus. However, in spite of taking all precautions complications are possible, even in experienced hands.This report describes a high central neural block, with loss of consciousness, following an attempt to block the stellate ganglion. The most probable cause was an inadvertent injection of local anaesthetic solution into the subdural extra-arachnoid space. Case historyA 38-year-old woman suffering from causalgia in the right arm was a frequent attender at the Pain Clinic. She obtained fairly good pain relief with spinal cord stimulation, but once or twice each year a more severe burning pain, originating from the affected area, necessitated additional therapy. Previous similar painful episodes had been treated with a stellate ganglion block using plain bupivacaine 0.5% which provided excellent analgesia lasting several months.The patient attended the Pain Clinic with another exacerbation and was scheduled for a stellate ganglion block. Standard routine monitoring precautions were taken: an intravenous gelatine solution was started, the heart rate was monitored by electrocardiogram (ECG) and arterial blood pressure was noninvasively measured at 5-minute intervals. The patient was placed in the supine position and the block performed using the anterior paratracheal approach at the C, level. A 22-gauge needle was inserted perpendicularly to the skin and bony contact was made. Withdrawal of the needle by 1-2mm and aspiration revealed no blood or cerebrospinal fluid (CSF).An initial dose of 2ml of plain bupivacaine 0.5% was injected. The patient reported a sensation of pressure, localised in the neck at the level at which the block was being performed. The aspiration test was repeated and again no signs of possible misplacement of the needle were detected. The infiltration was then completed, with a total dose of 10 ml of plain bupivacaine 0.5%, and the patient was placed in a 45" sitting position.Approximately 1 to 2 minutes after completion of the injection, the patient reported a tingling sensation in both arms and hands and complained of a n...

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