You are here

  • Home
  • Archive
  • Volume 38, Issue 1
  • Bilateral Loss of Neural Function After Interscalene Plexus Blockade May Be Caused by Epidural Spread of Local Anesthetics: A Cadaveric Study

Article Text

Article menu
Download PDFPDF
Brief Technical Report
Bilateral Loss of Neural Function After Interscalene Plexus Blockade May Be Caused by Epidural Spread of Local Anesthetics: A Cadaveric Study
  1. Gerhard Fritsch, MD*,
  2. Martin Hudelmaier, MD†,
  3. Thomas Danninger, MD*,
  4. Chad Brummett, MD‡,
  5. Matthias Bock, PD, MD*,§ and
  6. Mark McCoy, MD∥
  1. *Department of Anesthesiology, Perioperative Medicine and Intensive Care, and †Institute of Anatomy and Musculoskeletal Research, Paracelsus Medical University, Salzburg, Austria; ‡Department of Anesthesiology, Division of Pain Medicine, University of Michigan, Ann Arbor, MI; §Department of Anesthesiology I, Central Hospital of Bolzano, Italy; and ∥Division of Neuroradiology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria.
  1. Address correspondence to: Gerhard Fritsch, MD, Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria (e-mail: g.fritsch{at}salk.at).

Abstract

Background and Objectives Interscalene brachial plexus blockade is widely used in surgical procedures of the upper limb. Recently, we experienced the complication of a contralateral blockade after ultrasound-guided interscalene block. The clinical appearance was a blockade of both the ipsilateral and the contralateral cervical segments 6 to 8. We hypothesized that epidural spread of local anesthetics could be cause for this phenomenon.

Methods We conducted a cadaveric study using ultrasound for needle guidance of interscalene blocks in 5 cadavers by a single investigator using contrast agent. Injections were made either ventral (extrafascial) or dorsal (subfascial) to the prevertebral lamina of the deep cervical fascia. Computed tomography was obtained following each injection with contrast agent immediately after incremental injections of progressively higher volumes. Subsequently, contrast spread to anatomic landmarks was investigated by a radiologist.

Results After ultrasound-controlled injection of contrast agent beneath the prevertebral layer of the deep cervical fascia, 4 of the 5 investigated specimens showed contrast enhancement in the epidural space in the consecutive computed tomography scans. After extrafascial injection, none of the investigated specimens showed contrast enhancement in the epidural space.

Conclusions Contralateral blockade after ultrasound-guided interscalene injection of local anesthetics is very likely to be the effect of epidural spread. Future in vivo studies are needed to understand the implications of needle location and volume on epidural spread in interscalene blockade.

https://doi.org/10.1097/AAP.0b013e318277a870

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Footnotes

    • The authors declare no conflict of interest.

      The study was funded with financial support of the Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, and the Institute of Anatomy and Musculoskeletal Research at Paracelsus Medical University in Salzburg, Austria.

      Joseph M. Neal, MD, served as editor-in-chief for this article.

      Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.rapm.org).