Total spinal block in posterior interscalene single shot block procedure: A clinical case report

Abstract

Objectives. The interscalene block is used to anesthetize the brachial plexus, frequently applied during surgeries involving the upper extremities. It block can be performed using anterior and posterior approaches. Materials and methods. 49-year-old patient was chosen for pain analgesia elective left shoulder acromioplasty. Posterior interscalene block chosen for anesthesia. Anatomical landmarks and electrical stimulator were used to define the injection site and depth. After the needle reached required depth, aspiration test was performed with no blood and 40 ml of 1.5% Lidocaine and 10 ml of 0.5% Bupivacaine were administered. After a few minutes, the patient complained of weakness and lost consciousness. Arterial hypotension (70/40 mmHg) and respiratory failure were observed. The patient was intubated, and mechanical ventilation was initiated. The decision was made to perform surgery under endotracheal anesthesia with sevoflurane ma maintanance (MAC=1). After surgery, the patient was transferred to the Intensive Care Unit (ICU) where persistent arterial hypotension (85/46 mmHg), bradycardia (49 bpm), a Glasgow Coma Scale (GCS) score of 3, dilated pupils, and negative photoreaction were observed. Acute cerebral circulation disorder and hypoglycemic coma were ruled out. The complication of interscalene block—total spinal block—was considered. In the absence of an antidote for local anesthetics, it was decided to monitor the patient’s condition and provide symptomatic treatment with analgesics, low molecular weight heparin, H2 blockers, crystalloids, and sedation with propofol. The patient’s condition improved over time. After 2.5 hours, the patient regained normal vital functions and consciousness, achieving a GCS score of 15, and was successfully extubated. Results. The procedure of posterior interscalene block for a 49-year-old male resulted in a total spinal block. Conclusions. Performance of interscalene block using the posterior approach and nerve stimulator without ultrasound can lead to a life-threatening complication known as total spinal block.