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Excessive epidural block — FRCA Final MCQ

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ModerateRegional AnaesthesiaExcessive epidural blockFRCA Final

A 65-year-old man has an epidural infusion after thoracotomy. He reports increasing incisional pain but pin-prick testing shows a dense bilateral block from T2 to T8 and his legs are weak. Blood pressure is 82/45 mmHg after a recent bolus. What is the most appropriate pain management?

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Reveal the answer and explanation

Correct answer: E — Stop the epidural infusion and treat hypotension while reassessing block level

Dense high block with leg weakness and hypotension suggests excessive neuraxial spread rather than failed analgesia. The infusion should be stopped, haemodynamics treated and sensory/motor level reassessed. A further bolus could worsen high neuraxial blockade. Persistent or unexpected weakness after stopping local anaesthetic should trigger urgent investigation for compressive pathology.

Reference: RCoA epidural analgesia safety guidance; Association of Anaesthetists monitoring standards