INADVERTENT EXTRA-ARACHNOID (SUBDURAL) INJECTION OF A LOCAL-ANESTHETIC AGENT DURING EPIDURAL-ANESTHESIA - A CASE-REPORT

Profound hypotension occurring in a patient 2 hours after initiation o f combined general and epidural anaesthesia for a myocutaneous free-fl ap graft was found to be attributable to subdural/extra-archnoid injec tion of 0,5% bupivacaine. The initial diagnosis was based on a negativ e aspiration test, a delayed widespread sensory and sympathetic block, and the absence of any other obvious cause for the hypotension. This was confirmed by myelography, which demonstrated an extension of the c ontrast medium predominantly posteriorly in the spinal canal with exce ssive spread along the nerve roots. Posture and coughing did not affec t the spread.