Critical Care and Shock

Respiratory arrest following CT guided selective cervical nerve root injection

CT guided cervical nerve root injection is performed for diagnostic purposes or to reduce inflammation and pain in cervical radiculopathy. Steroid and local anaesthetic are injected under CT guidance around the nerve root. This is performed as an outpatient procedure with most patients being able to be discharged 15-30 mins after the procedure. CT guidance allows the operator to see the best pathway for the needle whilst visualising structures such as the carotid and vertebral artery.

It is generally a safe procedure, with one recent study by RS Pobiel et al showing out of 802 fluoroscopy guided cervical nerve root blockades there were no major complications. (1) Some major complications are reported in the literature however, the most cited being cerebral and spinal infarction and vessel penetration. We found 2 case reports of probable subdural/intrathecal injection of local anaesthetic (LA) and steroid causing temporary paralysis of both upper and lower limbs and laboured breathing but neither causing respiratory arrest. (2,3) We present a case of temporary paralysis and respiratory arrest requiring intubation following CT guided injection of bupivacaine 0.25% and triamcinolone acetonide for nerve impingement at C7 level.

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