I was doing a interscalene block for a shoulder replacement. Using a Stimplex needle, got good twitches at 0.5mA, nil on aspiration, and started injecting my bupivacaine 0.5%. Very quickly, and without warning (at about 5 mL) the patient groans, and falls unconscious. Thinking its just a faint, I place her flat, oxygen and waited. She didn't come around. In fact, she didn't breath. Her BP was low, pulse 40, apneic. Iintubated without using any drugs, and waited. And waited. And waited. BP and pulse improved quickly, but still apneic at 10 minutes.

My impression is I gave her a very high epidural or even a subarachnoid block, my needle being a bit deeper than I thought! Any other thoughts?

PS she woke up an hour later in ICU, remembers nothing of the incident, and wondered why her shoulder wasn't fixed!