Reactions 1086 - 28 Jan 2006

SBupivacaine

Cauda equina syndrome in an elderly patient: casereport

A 72-year-old man developed cauda equina syndrome afterreceiving intrathecal anaesthesia with bupivacaine.

The man, who was undergoing elective inguinal herniarepair, received a spinal injection of 0.5% hyperbaricbupivacaine 12.5mg [Marcaine]. The 90-minute surgicalprocedure was uneventful, but, the following morning, heexperienced defecation difficulties, and complained of urinaryretention, which required catheterisation, and impairedambulation. On neurological examination, he had impairedsensation to pinprick in both L5 dermatomes, in the perinealregion, and on the posterior part of his left calf. He also haddiminished reflexes in his knee and ankle joints, comparedwith his upper limb reflexes. A Lasegue’s test was negative. Hehad bilateral steppage gait resulting from foot-drop. MRIshowed he had no spinal stenosis or compression on thecauda equina nerve roots. He was diagnosed with caudaequina syndrome. One-month postoperatively, he had normalbowel function, and could void normally. He continued tohave complaints of painful dysesthesia in the right L5dermatome, and an intermittent aching pain in his right firsttoe, and he could still not walk properly. One-month,postoperative electromyography, showed varying degrees ofbilateral denervation and reinnervation in the S1, L4 and L5roots. Two years postoperatively, he still experiencedparaesthesia in the dorsal part of his right foot. He also hadsleep-altering, nocturnal aching cramps with involuntaryextension of his right first toe, and a moderate steppage gait,which impaired his walking.

[Treatment given not stated].Author comment: "Bupivacaine neurotoxicity is suggested

by the absence of any other identifiable cause for thisneurologic deficit."Chabbouh T, et al. Persistent cauda equina syndrome with no identifiablefacilitating condition after an uneventful single spinal administration of 0.5%hyperbaric bupivacaine. Anesthesia and Analgesia 101: 1847-1848, No. 6, Dec2005 - France 801029695

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Reactions 28 Jan 2006 No. 10860114-9954/10/1086-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved