[Case of high spinal anesthesia as a complication of an interscalenic brachial plexus block].

A case of high spinal anesthesia complicating an interscalene brachial plexus block is described. After an apparently straightforward location of the plexus with good paresthesias, the injection of 10 ml of local anesthetic caused a high spinal block whose main feature was apnea. The patient retained his consciousness until he was anesthetized with thiopentone and N2O-O2 and had a vivid recollection of the accident. The patient resumed spontaneous breathing after about 1 hour of artificial ventilation and 2 hours later at the end of surgery he was fully conscious without any residual sensory or motor block. The clinical picture compared to previous cases reported in the literature is commented on. A possible subarachnoid spread of the local anesthetic via the perineural space following intraneural injection is discussed. The author advocates the use of needles no longer than 1 inch for the interscalene approach to the brachial plexus.