Total reversible blindness following attempted stellate ganglion block.

A 51-year-old white man who had a crush injury of the right wrist and forearm 1 month before consultation, was being treated for posttraumatic sympathetic dystrophy. A series of stellate ganglion blocks was indicated. The patient had received two previous blocks without incident. The procedure was not new to him. He was relaxed and calm. The technique used was the paratracheal approach. A 25-gauge needle was inserted. After negative aspiration, we started to inject 10 ml of bupivacaine 0.25%. One milliliter was injected when the patient started moaning and moving his arm and hands, pointing to his face with his fingers. His face was very pale, his pupils were dilated bilaterally, and he was unable to speak. After 1 minute, when he recovered his speech, he told us that he was blind. He never lost consciousness, did not convulse, nor were his respirations or heart rate affected. Approximately 5 minutes passed before he was able to see again. Later he told us that his inability to speak was due to weakness of the tongue and jaw. At no time did he complain of pain. Referring to his blindness, he said that at first everything was black. Then