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Convulsions during Stellate Ganglion Block

A Case Report

Wilhelmina C. Korevaar, MD^*, Robert G. gurney, MD, and Paul A. Moore, DMD, PhD^*

*Postdoctoral Fellow, Dental Research Center, University of North Carolina Pain Clinic. Associate Professor of Anesthesiology, North Carolina Memorial Hospital. University of North Carolina Pain Clinic, Dental Research Center Building 210H. The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514, and North Carolina Memorial Hospital, Chapel Hill.

Abstract

Inadvertant intravascular injection is an important cause of toxic reactions to local anesthetics. The risk of acute central nervous system toxicity during stellate ganglion block is increased by the proximity of the carotid and vertebral arteries to the site of injection of the local anesthetic. Manifestations of injection into these arteries range from transient nausea and sedation to loss of consciousness and convulsions. With direct intra-arterial injection, the onset of toxicity is rapid, and the required dose of local anesthetic is low. In the present case, a generalized convulsion followed a 7.5-mg bupivacaine injection, presumably into the vertebral artery. Although this is well below the dose usually associated with toxic reactions, theoretical consideration of this and previous reports suggests that this is a reasonable expectation with direct injection into a vertebral artery.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999