Inadvert Intravenous Administration of Local Anaesthetic During Labour: A Case Report

Introduction: Local anaesthetics are widely used in the daily practice of the anaesthesiologists. Although in most part of the times no adverse effect are observed secondary to its use, accidental intravascular injection can be related to serious consequences. The objective of this case report is to describe an accidental intravascular administration of a local anesthetic during labour epidural analgesia. Methods: Clinical records of a complete epidural labour analgesia case were collected. Results: During an epidural blockade for labour analgesia, local anesthetic toxicity was acutely diagnosed after a bolus dose. This epidural catheter was promptly removed. Following the parturient informed consent and will, a second epidural catheter was introduced at a different lumbar level, with a subsequent successful analgesia, with no complications registered, with a normal delivery in the due time, with no morbidities either to the mother and the newborn. Discussion: After an incomplete success of the first bolus when the first epidural catheter has been used, a diagnostic bolus of Lidocaine showed that this catheter was actually in an intravascular space. The diagnostic was purely clinical, given the highly typical clinical signs that were observed. These signs were so clear that no other diagnostic procedure was necessary. The fact that labour analgesia was resumed after a second catheter was introduced (this time with complete success) showed a good confidence relationship between doctor and patient, which is of paramount importance during Anesthesiology practice. Conclusions: Intravascular injection of local anaesthetics could be prevented following some safe steps. In cases when it is not primarily identified, a transparent dressing could allow observation of blood inside catheter and help to make the diagnosis.