Injection into the extra‐arachnoid subdural space

Mehta, Mark; Maher, R.M.

doi:10.1111/j.1365-2044.1977.tb10077.x

Cited by 53 publications

(12 citation statements)

References 3 publications

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“…by radiologists in performing injection of neurolytic agents for the relief of intractable pain [6]. The position of the catheter in the subdural space has been confirmed by X rays using contrast [I-3,5, 7,8], as well as computerised axial tomographic scan [9].…”

Section: Discussionmentioning

confidence: 99%

Subdural or epidural?

Ralph

Williams²

1996

Anaesthesia

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Section: Discussionmentioning

confidence: 99%

Subdural or epidural?

Ralph

Williams²

1996

Anaesthesia

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“…Unlike the epidural space, this space extends from the lower border of the second sacral vertebra into the cranial cavity. 3,4 It has no communication with the subarachnoid space but is continued on cranial and spinal nerves for a short distance. The dura and arachnoid are attached together on the ventral root, making the space very small ventrally.…”

Section: Discussionmentioning

confidence: 99%

Subdural block: A possible cause of transient aphasia following spinal anaesthesia

Bhardwaj¹,

Kiran²,

Kaur³

et al. 2015

Sri Lankan J Anaesthesiol

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Central neuraxial blockade is a commonly performed anaesthetic technique for lower limb orthopaedic surgeries. Although it is considered a safe and reliable technique, occasionally an unexpectedly high or low level of block can be achieved due to accidental injection of local anaesthetic in a meningeal plane other than that desired. Here we report a young male who complained of aphasia and difficulty in breathing immediately after spinal anaesthesia. He had a high sensory block extending to C3 dermatome. His haemodynamics remained stable throughout the surgery. Speech returned to normal in 15 minutes. Subdural block was speculated as a cause for this unusual presentation.Keywords: subdural block, aphasia, spinal anaesthesia Case ReportCentral neuraxial blockade is a common anaesthetic technique for lower limb orthopaedic surgeries. Although it is considered a safe and reliable technique, occasionally an unexpectedly high or low level of block occurs due to accidental injection of local anaesthetic in a meningeal plane other than that desired.1 Even cardiac arrests have been reported despite stable haemodynamics.2 A greater awareness about variable presentations is important as timely management is essential to avoid critical complications. We hereby report a case that developed aphasia with unexpectedly high sensory level immediately following spinal anaesthesia.A 19 year old male weighing 65 kg, with a height of 167cm belonging to ASA physical status 1 came to emergency operation theatre for interlocking nail for fracture shaft of right femur. His general physical status and all haematological investigations were unremarkable.In the operation theatre, routine monitors were attached and his vital signs recorded. Peripheral venous line was established with 18G cannula on right forearm and Ringer's lactate infusion was started. Under aseptic precautions subarachnoid block was given with 23G Quinke's needle in L3/4 space in midline in sitting position in a single atraumatic attempt. Hyperbaric bupivacaine (0.5%) 2.8ml was injected after obtaining clear free flow of cerebrospinal fluid. As the patient was placed in supine position, he became restless and was unable to speak. Immediately 100% oxygen was administered. His spontaneous respiratory efforts were apparently normal. His heart rate was 86/min, regular, blood pressure was 128/64 mmHg and oxygen saturation (SpO2) 98%. Within few seconds, he started sweating with irregular breathing. His breathing was assisted manually with few breaths with a Bain's circuit. He communicated only by moving his head. Level of the spinal block was assessed quickly and it was C3. After five to seven minutes, he started feeling comfortable, sweating decreased and was able to speak in a weak voice. His speech reverted to normal voice in fifteen-twenty minutes. After 20 minutes, sensory level of block had receded to T4. At this time, surgery was commenced and it went on uneventfully for 90 minutes. His haemodynamic parameters were within normal range throughout the surgery. At the tim...

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“…Analgesic solutions introduced into the subdural space characteristically ascend against gravity very slowly, reaching the cranial cavity. 6 The subdural space is potentially much smaller than the extradural space and injections of a large volume of analgesic solution into the subdural space would be expected to cause more extensive neural blockade than the same volume of the solution in the extradural space. Administration of this volume of the local analgesic agent into the subarachnoid space would result in complete unconsciousness, cardiovascular collapse and failure of respiration.…”

Section: Discussionmentioning

confidence: 99%