Unintended epidural placement of a thoracic paravertebral catheter in a patient with severe chest trauma.

OBJECTIVE: Severe pain can lead to ventilatory compromise in patients with multiple rib fractures. Regional anesthetic techniques, including continuous thoracic paravertebral and thoracic epidural blocks, can be useful in reducing this pain and subsequent morbidity due to respiratory compromise. Thoracic paravertebral block can result in significant complications. Presumed epidural spread of injected medication has been described with thoracic paravertebral block. High-quality radiographic images of an attempted placement of a thoracic paravertebral catheter in the epidural space have not been reported. We present these images to highlight the occurrence of this complication. SETTINGS AND PATIENTS: In this case, we report an attempted placement of a thoracic paravertebral catheter that passed into the epidural space. High-fidelity, three-dimensional computer tomography images and the management of the unintended epidural catheterization are presented. RESULTS AND
CONCLUSIONS: In the setting of severe chest trauma, the potential risk of unintended placement of an intended thoracic paravertebral catheter in the epidural space is graphically illustrated as a potential risk of this procedure. Wiley Periodicals, Inc.