Inadvertent high central neuraxial block and possible total spinal anaesthesia occurring after nerve stimulation guided thoracic paravertebral block

We report a case of a 74 years-old-woman scheduled for breast quadrantectomy and axillary dissection who developed high subdural block and hemodynamic instability after a nerve stimulator guided thoracic paravertebral blocks (TPVBs). We supported vital functions until, after 170 minutes from TPVBs, the patient fully recovered. Even if TPVB is described as a procedure at low-risk, as an excellent procedure for postoperative pain control and as a valid alternative to general anesthesia for breast surgery, complications may be life-threatening. We hypothesize that ultrasound can make the safest technique.