The Storm After The Near-Failed Epidural Anaesthesia

To the Editor: Sub-arachnoid or sub-dural injection or migration of the catheter is a known complication of the epidural block. The test dose helps in ruling out a sub-arachnoid or vascular injection. We report a case of accidental sub-dural injection of drug as a complication of epidural anaesthesia. A 38 year old woman, with 5'5 � height and 55 kg weight was scheduled for vaginal hysterectomy under epidural anaesthesia. Her pre-operative pulse rate was 85 bpm and blood pressure 130/86 mm of Hg. After local anaesthesia infiltrations, a 16 gauge epidural needle was used through para-median approach at L 3-L4 level by loss of resistance to air technique. After confirmation of negative aspiration of blood and CSF, an epidural test dose of 3cc of 2% lignocaine with adrenaline was administered. Absence of motor blockade and tachycardia confirmed the epidural placement of needle. 20cc of 0.25% bupivacaine + 1% lignocaine with 25 g fentanyl was injected. Haemodynamics were monitored and sensory level checked. At the end of twenty minutes the blockade was patchy & around T 10-T11 segments. Assuming