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Inadvertent high central neuraxial block and possible total spinal anaesthesia occurring after nerve stimulation–guided thoracic paravertebral block

Department of Anaesthesia, Intensive Care and Palliative Care - Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy


We report a case of a 74 years-old-woman scheduled for breast quadrantectomy and axillary dissection who developed high subdural block and hemodynamic instability after a nerve stimulator guided thoracic paravertebral blocks (TPVBs).
We supported vital functions until, after 170 minutes from TPVBs, the patient fully recovered.
Even if TPVB is described as a procedure at low-risk, as an excellent procedure for postoperative pain control and as a valid alternative to general anesthesia for breast surgery, complications may be life-threatening.
We hypothesize that ultrasound can make the safest technique.

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