A fatal accidental subarachnoid injection of lidocaine and levobupivacaine during a lumbar paravertebral block.

摘要: Paravertebral block (PVB) is the technique of injecting a local anesthetic solution alongside vertebral column, close to where spinal nerves emerge, resulting in unilateral somatic and sympathetic nerve blockade. Here reported fatal case involving 60-year-old woman with spondylitis arthropathy, who developed cardiac respiratory arrest 40min after receiving an accidental subarachnoid injection (L5-S1 bilaterally) depomedrol lidocaine levobupivacaine. A complete autopsy including histological toxicological analyses was performed order establish cause death. Liquid/liquid extraction (LLE) GC-MS analysis were according previously published method. Lidocaine bupivacaine detected both blood, at concentrations 14.8mg/L 13.3mg/L respectively, cerebrospinal fluid (CSF) 287.1mg/L 464.2mg/L respectively. Both also urine. The findings along allowed us that levobupivacaine had led progressive hypotension normovolaemic shock caused by severe ganglionic block, determining patient's