• The Korean Journal of Pain
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• v.6 no.2
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• pp.265-269
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• 1993

Subdural block is a rare but well recognized complication of epidural anesthesia. The placement of local anesthetics into the subdural space can lead to potentially life-threatening conditions. A healthy 46-year-old women underwent total abdominal hysterectomy under continuous lumber epidural anesthesia. The technical procedure for continuous epidural catheterization went smoothly without a single problem. However, signs of high epidural block such as apnea, cranial nerve paralysis and pupil dilatation developed gradually, about 20 minutes after the epidural injection of 2% lidocaine 20 ml through the epidural catheter. Such extensive segmental block can only be explained as the result of injection into subdural space even if it was not confirmed radiologically.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.155-159
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• 1998

Epidural neurolysis with phenol has appeared in literature since 1960. Complications due to accidental subdural block is a rare and unexpected sensory and/or motor disturbance, but it does occur. A 74 years old woman had postherpectic neuralgia for 3 weeks and VAS score of 10. She was treated with intercostal nerve block and intravenous infusion of lidocaine for 7 days and VAS score decreased to 6. To proceed further, we decided to perform epidural neurolysis with 4% phenol 1.5 ml. During thoracic epidural catherization, we encountered unexpected subdural catheterization in subdurographic finding, but we could not precisely rule out subdural catheterization. We had to check CT for exact location of catheter tip. We then performed subdural neurolysis with phenol. This procedure reduced VAS score to between 3 and 4, and we removed the catheter. She had no complication.

• Journal of Korean Neurosurgical Society
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• v.58 no.5
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• pp.483-486
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• 2015

Cervical epidural steroid injection is frequently used in the conservative management of neck pain and cervical radiculopathy. Epidural cervical transforaminal injections are usually well-tolerated with mild side effects such as transient decreased sensory and motor function, or headache due to dural puncture. Although there are a few case reports about adverse effects of cervical epidural injection in the literature, it can cause severe complications such as large hematoma, infarction by spinal vascular injury. Subdural hematoma has been occurred much less common rather than epidural hematoma in the spinal cord. We report a rare catastrophic case of cervical spinal subdural hematoma with quadriparesis after cervical transforaminal epidural block.

• The Korean Journal of Pain
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• v.14 no.1
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• pp.104-109
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• 2001

We describe the accidental injection of local anesthetics containing steroid into the subdural space during an attempted lumbar epidural injection for intractable radiculopathy in a patient with failed back surgery syndrome. A 24-year-old man complained of severe radiating pain to left lower extremity and showed a walking disturbance and severe lumbar scoliosis. The MRI finding was a left paramedian recurred disc herniation on L4-5 in a laminectomy state. Several therapeutic modalities such as epidural steroid injection, transforaminal injection, L2 root block, medication, and exercise therapy, etc failed. Initially, during epidural block at L4-5 under fluoroscopic guidance, a railroad track appearance appeared on epidurogram suggesting the presence of a subdural space. A second epidural block was tried at L5-S1. Following confirmation of epidural space upon epidurogram, 6 ml of 0.5% lidocaine including triamcinolone 40 mg was injected. The patient showed signs of the subdural injection including an unexpectedly high sensory block (T2) and a motor weakness of both lower extremities. Following this event, the severe radiculopathy and lumbar scoliosis were improved. Therefore, we conclude that subdural injection of steroid could be helpful in intractable radiculopathy, especially in the failed back surgery syndrome. However, it must be used cautiously with careful patient selection.

• The Korean Journal of Pain
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• v.22 no.1
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• pp.83-87
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• 2009

Case reports after accidental subdural injection during attempted epidural block have usually described extensive neuraxial blocks with a characteristic radiographic appearance on contrast injection. We experienced a case of cervical subdural injection with unusual clinical findings and radiographic appearance. A 51-year-old female patient with central herniated nucleus pulposus at cervical (C5/6) and lumbar level (L4/5, L5/S1) was referred to the pain clinic. During attempted cervical epidural block at the C6/7 interspace with fluoroscopy, injection of the 4 ml contrast showed posterior spread at cervical level. After cervical epidural steroid injection, the contrast was also confined to the posterior aspect of the spinal canal at lumbar level with fluoroscopy. In order to discriminate subdural space from epidural space, we performed transforaminal epidural injection of the 2 ml contrast at the L5/S1 interspace and we could confirm cervical epidural injection was made into the subdural space. We discuss the clinical characteristics of a subdural injection and the appearance of the cervical and lumbar subdurogram.

• Journal of the Korean Orthopaedic Association
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• v.56 no.2
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• pp.178-182
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• 2021

Spinal hematomas are a rare but serious complication that is typically observed in the epidural space. Spinal subdural hematomas are a dangerous clinical situation because of their potential to cause significant compression of the neural elements and can be mistaken easily for spinal epidural hematomas. This paper reports a case of a severe whole lumbar subdural hematoma after a simple epidural injection that was treated with surgical decompression with excellent clinical results.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.164-167
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• 2006

Background: There have been an increasing number of reports about infection-related complications after epidural block, and the analysis of these previous reports may offer valuable information for the prevention and treatment of such complications. Methods: We searched for complications about infection that was related to epidural blockade procedures by using the Medline Search program. We analyzed the types of infection-related complications as well as the potential risk factors, the time course from symptom development to treatment, the causative organisms and the treatment outcomes. Results: Seventeen cases were identified. The types of complications were epidural abscess, subdural abscess, spinal arachnoiditis, bacterial meningitis and aseptic meningitis. Five patients received a single block and twelve patients received a continuous block with catheterization. The most common site of epidural catheterization was the lumbar area and eight patients had indwelling catheters for less than fifteen days. Eight patients had a diabetes mellitus as a risk factor and fourteen patients showed less than seven days from the development of symptoms to treatment. Eleven patients received laminectomy and intravenous antibiotics as a treatment and eight patients had full recovery without neurological deficit. Conclusions: Early diagnosis and treatment is essential for the favorable outcome of infection-related complication after epidural block. In addition, absolute sterile technique should always be performed and patient education concerning these potential complications must be accompanied.

• The Korean Journal of Pain
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• v.8 no.1
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• pp.159-163
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• 1995

Accidental high epidural block is a rare but serious complication. It can result from many factors, which include the volume and concentration of drug, posture, puncture site, age, pregnancy or intra-abdominal mass, and patients' height and weight. We had a case of accidental high epidural block recently. This is a case report which was confirmed by an epiduragram. A healthy 50-year-old woman with a huge uterine myoma was scheduled for a total abdominal hysterectomy under continous epidural analgesia. Epidural catheterization was carried out smoothly. However, an unexpected hypotension was noticed after an epidural injection of 2% lidocaine 25 ml. Thereafter, the patient was intubated and her respiration was controlled during the operation. Using the 5mg of ephedrine, her blood pressure and pulse were well maintained. The scheduled operation was carried out for one hour uneventfully, but after the operation, she felt paresthesia on her hands in the recovery room. To differentiate between the high epidural and the subdural blocks. We injected 5 ml of a water soluble Niopam 300 through the catheter postoperatively. It was observed on the epiduragram that the catheter was placed in the epidural space. It was suggested that the high epidural block was induced from the widespread diffusion through the narrowed epidural space due to the engorgement of the epidural venous plexus by the patient's huge uterine myoma.

• The Korean Journal of Pain
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• v.7 no.2
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• pp.162-169
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• 1994

Blockade of cervicothoracic sympathetic ganglion (stellate ganglion controls pain on face, head, neck, shoulder, upper limbs, and upper chest, including their viscera and sympathetically maintained pain. This procedure also increases blood flow to the above areas and relieves hyperreactivity of sympathetic nervous system. Clinically, repeated stellate ganglion blocks with local anesthetic agent may become difficult with complications such as accidental intravascular or subdural injection, recurrent laryngeal nerve or bracheal plexus paralysis, pneumothorax and edema on injection site. Therefore, at times long-term cervicothoracic ganglion block with neurolytics is necessitated but its applications are prohibited by the critical structures surrounding ganglion. There are also few reports of neurolytic stellate ganglion block. This study was performed to observe the complications, gross changes of surrounding structures, and microscopic findings of ganglion cells after neurolytic block and to certify the possibility of clinical use of neruolytic stellate ganglion block. The unilateral superior cervical sympathetic ganglion of rabbit was blocked with absolute ethyl alcohol 0.4 ml at the level of cricoid cartilage. Normal ganglion was used as a control and 5 animals were sacrificed at each intervals of 7, 15 and 50 days after block. The results were as follows; 1) All experimental animals showed no specific changes of behavior, motor function. No necrotic tissues were present in the block area during the observation period. There were some gross scar tissues along the fascia of muscles surrounding the needle injection site, but gross atrophy of muscles or injured major vessels were not found. 2) Microscopically, structures of normal ganglion of rabbit were very similar to those of humans. Seven days after absolute ethyl achohol injection there were marked edema of ganglion cells and nuclei with irregular nuclear membrane. Some of the ganglion cells lost their nuclei and showed degenerative changes. Fifteen days after block, cell edema were decreased and loss of the Nissl's body was prominant. The ganglion cell structures looked close to normal but the cytoplasm and nucleus were generally contracted 50 days after block. These results suggest absolute ethyl alcohol injection on cervical sympathetic ganglion with above method mainly blocks pre- and post-synaptic fibers and the long-term neurolytic blockade of this ganglion may be possible in rabbits.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.276-279
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• 2001

Epidural steroid injection is one method of releiving chronic back pain. However, problems with the loss of resistance to air technique include the possible subarachnoid or subdural injection of air resulting in headache, venous air embolism, and the introduction of air bubbles into the epidural space. Pneumocephalus is a rare complication of epidural block for epidural steroid injection. We report a case of a 58-year-old woman who developed a severe headache and posterior nuchal pain with incomplete oculomotor palsy due to pneumocephalus occuring after an epidural steroid injection.