Total spinal anaesthesia with "Interscalene brachial plexus block by Winnie approach"

Total Spinal Anesthesia Following an Interscalene Block Treated with Intravenous Lipid Emulsion

“…These complications included peripheral nerve damage both persistent and recoverable, local anesthetic toxicity manifesting as either cardiovascular events or seizures, phrenic nerve palsy, pneumothorax, and total spinal paralysis [2]. In the four cases reported by Scammell et al patients quickly developed total spinal paralysis after injection of the block but spontaneously recovered over several hours with cardiorespiratory support [3-6]. In four cases reported by Benumof, another by Mostafa, and one by Barutell, spinal block was followed by permanent neurologic deficits of varying degrees as well as evidence of spinal cord damage on MRI [7-9].…”

“…The cause for this unusual complication of total spinal anesthesia is not entirely clear. Proposed mechanisms include intraneural injection and spreading of local anesthesia centrally, injection directly into the intrathecal space, or injection into a lateral projection of the dural sac outside of the intervertebral foramen known as a “dural cuff” anatomical variation [6]. Furthermore, it is unclear why some cases are associated with permanent neurologic deficits.…”

“…However, several cases document spontaneous recovery in a similar timeframe as our case without utilizing ILE therapy. Those cases were treated exclusively with supportive care including intubation, mechanical ventilation, vasopressors, antidysrhythmics, fluids, and sedation [3-6]. Additionally, it is unclear if ILE therapy would reduce the poor neurologic outcomes of some of the cases.…”