Reactions 1397 - 14 Apr 2012

SBupivacaine

Cauda equina syndrome?: case reportA young female patient [age not stated] developed cauda

equina syndrome after receiving spinal anaesthesia withbupivacaine.

The female patient underwent a caesarean section,which was performed under spinal anaesthesia with 2.4mLof 0.5% hyperbaric bupivacaine, injected in theL2–3 interspace. A successful spinal puncture was madeafter three attempts, with blood-stained CSF aspirated onthe first attempt. Her 45-minute surgery was uneventful.Twelve hours after surgery, the anaesthetic effect had notimproved, and the following day, she developed urinaryand faecal incontinence.

The female patient was managed conservatively;however, after 15 days, her condition had not improved.She was referred to another hospital, where examinationrevealed bilateral sensorimotor deficit in her lower limbsand loss of sensation in the perineal region. She wasdiagnosed with cauda equina syndrome. Lumbosacral MRIfindings were consistent with arachnoiditis, includingthickening of the cauda equina nerve roots at L2–3. Shereceived steroids, and her lower limb weakness slowlyimproved over 3 months.

Author comment: "The most like causes in our case couldbe neurotoxicity, haematoma or trauma to nerves or spinalcord. . . Neurotoxicity of local anaesthetic is usually due tomaldistribution."Jain M, et al. Cauda equina syndrome following an uneventful spinal anaesthesia.Indian Journal of Anaesthesia 54: 68-69, No. 1, Jan-Feb 2010. Available from:URL: http://dx.doi.org/10.4103/0019-5049.60505 - India 803069150

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Reactions 14 Apr 2012 No. 13970114-9954/10/1397-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved