[Transient second-degree A-V block during an epidural procedure].

A 26 year old pregnant female had a left ovarian tumor and was scheduled to have an operation. No specific complication was noted preoperatively except pregnancy of 16 weeks and one day. Spinal anesthesia for the operation and continuous epidural catheter placement for postoperative pain relief were planned. During the epidural procedure on L2-3 under left lateral recumbent position, patient developed a bradycardia when the tip of Tuohy needle touched the 3rd lumbar bone (lamina arcus vertebrae). This bradycardia occurred three times and the last episode was recorded on the ECG (Fig 2). Blood pressure at this period was 82/44 mmHg, but patient did not complain any discomfort. The recorded ECG showed II degree A-V block (Wenkebach type). We considered this A-V block is probably due to sharp pain from touching of Tuohy needle on the lamina arcus vertebrae. This kind of periosteal pain is sometime associated with vagal stimulation and it could produce II degree A-V block. During a spinal or epidural procedure, ECG should be monitored and we have to pay attention to these kinds of arrhythmia to prevent more profound hemodynamic changes.