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Failed spinal anesthesia after a psoas compartment block

[L’échec de la rachianesthésie après le bloc de la loge du psoas]

Scott A. Lang, MD FRCPC^*, Chris Prusinkiewicz, MD^* and Ban C.H. Tsui, MD FRCPC

^* From the Department of Anesthesia, Foothills Hospital, University of Calgary, Calgary; and
the Department of Anesthesiology and Pain Medicine, University of Alberta Hospitals, Edmonton, Alberta, Canada.

Address correspondence to: Dr. Ban C. H. Tsui, Department of Anesthesiology and Pain Medicine, University of Alberta Hospitals, 8-120 Clinical Sciences Building, Edmonton, Alberta T6G 2G3, Canada. Phone 780-407-8861; Fax: 780-407-3200; E-mail: btsui{at}ualberta.ca

Purpose: To report the case of a patient who experienced failed spinal anesthesia following a psoas compartment block (PCB) and discuss its implications.

Clinical features: A 70-yr-old male was scheduled for a right total hip arthroplasty. He agreed to a PCB for postoperative analgesia and a spinal anesthetic. The spinal anesthetic was performed after completion of the PCB. Free flow of clear fluid was demonstrated at the beginning and at the end of the presumed intrathecal injection. General anesthesia had to be induced because of failure of the spinal anesthetic. The patient awoke from his general anesthetic with a functional PCB and no evidence of residual neuraxial anesthesia. The possibility of epidural spread of local anesthetic from the PCB impairing the ability to perform spinal anesthesia is discussed and reviewed. We hypothesize that local anesthetic in the epidural space may have falsely reassured the anesthesiologist that the needle was properly placed.

Conclusion: We describe a case of failed spinal anesthesia following a PCB and discuss its implications.