The effect of the direction of the needle bevel in lumbar epidural analgesia

hysterical hyperventilation was made and treatment initiated accordingly but, despite repeated injections of diazepam and calcium salts, hyperventilation and muscle spasm persisted. The diagnosis was therefore reviewed, and the epidural infusion discontinued. It was considered necessary to anaesthetise and intubate the patient to control her pain, muscle spasm and hyperventilation and protect her airway. Muscle spasm and hyperventilation persisted despite fentanyl and nitrous oxide anaesthesia. The epidural catheter was removed and within 15 minutes muscle tone had returned to normal and hyperventilation had ceased. The nitrous oxide was discontinued and the patient was extubated. The patient felt well when she woke up and she had no recall for events following her Caesarean section. Crawford has reported interscapular pain following the infusion of Hartmann’s solution into the epidural space4 but has encountered no problems with epidural saline (personal communication). Craig & Habibs have reported a flaccid paresis following the injection of 40 ml of 0.9% sodium chloride through an indwelling catheter into the epidural space. They believe that 1.5% benzyl alcohol, present as a preservative, may have been responsible. We suggest that the catheter caused nerve root irritation in our patient. Painful muscle spasm resulted when the effects of the bupivacaine waned and this caused the patient to hyperventilate and to produce diagnostically confusing carpal spasm. Our patient’s subsequent recovery was complete and uneventful and she did not develop a spinal headache.