Inadvertent epidural anesthesia associated with catheterization following continuous psoas compartment block in a patient with scoliosis

Abstract

Rationale: Psoas compartment block (PCB) is typically performed using surface anatomical landmarks and neurostimulation for guidance. However, anatomical anomalies, such as scoliosis, make this technique unreliable, posing a challenge for the anesthesiologist when inducing regional anesthesia. Patient concerns: A 69-year-old woman with lumbar scoliosis scheduled for total hip arthroplasty underwent PCB with catheterization. Diagnoses: Inadvertent epidural anesthesia with catheterization following PCB was diagnosed using a lumbar radiograph. Interventions: Due to hypotension induced by local anesthetic (LA) epidural diffusion, the patient received intravenous hydration and vasopressor. Since bilateral sensory block was noted at the T3 level, with an incomplete motor blockade in both legs, the surgery was performed under epidural anesthesia. Outcomes: The patient remained hemodynamically stable throughout the duration of the surgical procedure. The surgery was uneventful and without further complications. Lessons: Patients with lumbar scoliosis are highly at risk of LA epidural diffusion, following PCB using traditional landmark-based approach. Other nerve-localizing technique can minimize the risk of this complication.