Reactions 1284 - 16 Jan 2010

SBupivacaine

Spinal subdural haematoma leading to caudaequina syndrome in an elderly patient: casereport

An 86-year-old man developed cauda equina syndromedue to a subdural haematoma after receiving spinalanaesthesia with bupivacaine.

The man received 0.5% hyperbaric bupivacaine 3mL,injected into his subarachnoid space; he subsequentlyunderwent an uneventful total hip replacement. Enoxaparinsodium was started 12 hours after surgery. He reportedslight wound pain on the day of his operation. Rapidlyprogressive motor and sensory deficits developed in hislegs 96 hours after surgery, associated with mild lowerback pain. Muscle weakness was observed in all lower-limbmuscle compartments, and he had overflow incontinence.Cauda equina syndrome was diagnosed. An MRI scan of hislumbar spine revealed a subdural haematoma, which wascausing compression of his cauda equina nerve roots. Amoderately narrow canal was evident at the level of L3 andL4.

A catheter was inserted, and the man underwentdecompressive laminectomy, as well as a durotomy toremove the haematoma. A slight improvement in his motorfunction was seen during his hospital stay, and he wastransferred for rehabilitation. One year later, his motorfunction remained unchanged, and his bladder control hadnot returned; he was still unable to walk.

Author comment: "In our patient the presence of anarrow lumbar canal may have contributed to the rapidlyprogressive motor dysfunction and the poor outcome."Moussallem CD, et al. Late spinal subdural haematoma after spinal anaesthesia fortotal hip replacement. Journal of Bone and Joint Surgery - British Volume 91:1531-1532, No. 11, Nov 2009. Available from: URL: http://dx.doi.org/10.1302/0301-620X.91B11.22258 - Lebanon 803004433

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Reactions 16 Jan 2010 No. 12840114-9954/10/1284-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved