BACKGROUND: A subdural injection is a rare complication of neuraxial anesthesia where medication is accidentally injected into the potential space between the dura mater and arachnoid mater of the spinal cord. Subdural blocks are typically underdiagnosed due to their variable presentation; failed early detection can lead to significant long-term consequences.

CASE REPORT: This is a unique case of a 33-year-old parturient who presented for epidural placement during which a 3 mL subdural injection of preservative-free 1.5% lidocaine with 1:200,000 epinephrine test dose led to rapid clinical deterioration resulting in respiratory arrest.

CONCLUSIONS: The objective of this case is to highlight atypical clinical features of an accidental subdural injection, detail the successful anesthetic management of a subdural injection, and emphasize the need for a high index of suspicion for subdural placement in patients receiving neuraxial anesthesia who develop an unexpected sensory or motor response following medication administration.

KEYWORDS: Subdural injection, epidural anesthesia, obstetric anesthesia, respiratory arrest, test dose