Reactions 1336 - 29 Jan 2011

SBupivacaine

Trigeminal nerve and facial nerve palsy: casereport

A 29-year-old woman developed trigeminal nerve andfacial nerve palsy following anaesthesia with bupivacaine.

The woman presented for emergency cesarean section at38 weeks’ gestation. A needle-through-needle combinedspinal-epidural technique was used, and 1.5mL of isobaricbupivacaine 0.75% was injected into the subarachnoidspace. When turned on her back, she reported tonguenumbness. After 5 minutes, a sensory block was obtainedat the T6 level. Following an uneventful cesarean section,examination showed that she had no upper limb motorblock. However, she had slight reduced sensation over herright face and tongue. The epidural catheter, which had notbeen used, was removed. She noted difficulty speaking andthe following morning, 8 hours postoperatively, she awokewith an altered sensation in her right face. Examinationdemonstrated numbness on the right side of her face andanterior two thirds of her tongue, and absence of thenasolabial fold. She was unable to close her eyes, or moveher mouth and lower face on the right side. She wasdiagnosed with trigeminal and right lower motor neuronfacial lesions.

Prednisone was administered, and the woman receivedphysical therapy including facial nerve stimulation. Within6 weeks, she had nearly recovered and was able to puckerher lips, show her teeth and close both eyes. Hernumbness had improved; however, she continued to showminor facial asymmetry.Fang JY, et al. Trigeminal nerve and facial nerve palsy after combined spinal-epidural anesthesia for cesarean section. Journal of Clinical Anesthesia 22: 56-8,No. 1, Feb 2010 - China 803048550

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Reactions 29 Jan 2011 No. 13360114-9954/10/1336-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved