{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T18:39:00Z","timestamp":1761676740275,"version":"3.40.5"},"reference-count":20,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,7,10]],"date-time":"2019-07-10T00:00:00Z","timestamp":1562716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Cervical epidural steroid injection (<jats:styled-content style=\"fixed-case\">CESI<\/jats:styled-content>) with local anesthetics is commonly used to treat neck pain and radicular pain of the upper extremity. Local anesthetic systemic toxicity (<jats:styled-content style=\"fixed-case\">LAST<\/jats:styled-content>) occurs shortly after injection as a complication; however, delayed onset is a very rare event, especially in central nervous system (<jats:styled-content style=\"fixed-case\">CNS<\/jats:styled-content>) block.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case report<\/jats:title><jats:p>We present a case in which delayed onset of <jats:styled-content style=\"fixed-case\">LAST<\/jats:styled-content> occurred in a patient who received <jats:styled-content style=\"fixed-case\">CESI<\/jats:styled-content> for cervical and arm radiating pain due to a cervical disc protrusion. We performed the interlaminar approach for <jats:styled-content style=\"fixed-case\">CESI<\/jats:styled-content> using fluoroscopic guidance. After confirming the location of the epidural space using the loss of resistance technique and spreading of contrast agent (Telebrix<jats:sup>\u00ae<\/jats:sup>30), a mixture of 0.25% levobupivacaine 12.5\u00a0mg (5\u00a0mL in volume), hyaluronidase 1,500\u00a0<jats:styled-content style=\"fixed-case\">IU<\/jats:styled-content> (1\u00a0mL), dexamethasone 5\u00a0mg (1\u00a0mL), and normal saline 3\u00a0mL was administrated. After 50\u00a0minutes of injection, the patient showed <jats:styled-content style=\"fixed-case\">CNS<\/jats:styled-content> toxicity (unconsciousness, seizure) with normal blood pressure and tachycardia; therefore, she was immediately sedated with intravenous midazolam (3\u00a0mg), and 15\u00a0L\/min of oxygen was administered. The patient fully recovered after 30\u00a0minutes of sedation without any sequelae.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Delayed onset of <jats:styled-content style=\"fixed-case\">LAST<\/jats:styled-content> is a rare complication of a common procedure in <jats:styled-content style=\"fixed-case\">CESI<\/jats:styled-content>, so it is important to be aware of this complication and the presentation of toxicity.<\/jats:p><\/jats:sec>","DOI":"10.1111\/papr.12802","type":"journal-article","created":{"date-parts":[[2019,6,5]],"date-time":"2019-06-05T08:43:27Z","timestamp":1559724207000},"page":"762-766","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["An Unusual Delayed Onset of Systemic Toxicity After Fluoroscopy\u2010Guided Cervical Epidural Steroid Injection With Levobupivacaine: A Case Report"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7506-1375","authenticated-orcid":false,"given":"Hee Yong","family":"Kang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Kyung Hee University Hospital Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeong Eun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Kyung Hee University Hospital Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yun Jong","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Kyung Hee University Hospital Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sung Wook","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Kyung Hee University Hospital Seoul 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