Total spinal anaesthesia in association with insertion of a paravertebral catheter

An association between intercostal nerve block and the development of a tot al spinal is rare. Usually, subarachnoid injection is considered to have fo llowed intraneural placement or inadvertent entrance into a dural cuff exte nding beyond an intervertebral foramen. We report a patient that followed i njection of local anaesthetic into a paravertebral catheter sited at surger y in the thoracic paravertebral space of a patient undergoing thoracotomy. This was a life-threatening event that occurred on two occasions before the definitive diagnosis was made. It is considered likely that the paraverteb ral catheter entered an intervertebral foramen and the tip perforated the d ura.