An association between intercostal nerve block and the development of a total spinal is rare. Usually, subarachnoid injection is considered to have followed intraneural placement or inadvertent entrance into a dural cuff extending beyond an intervertebral foramen. We report a patient that followed injection of local anaesthetic into a paravertebral catheter sited at surgery 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 paravertebral catheter entered an intervertebral foramen and the tip perforated the dura.

Prophylactic oral ephedrine reduces the incidence of hypotension after subarachnoid block (1"3-1"4) and iv fluids, the total dose of ephedrine supplement in Group I was 4.3 + 4.8 mg compared with 11.6 + 9.4 mg in Group H (P < 0.01