Reactions 1416 - 25 Aug 2012

SBupivacaine

Lower limb neurological deficit in an elderlypatient: case report

An 84-year-old man developed a bilateral symmetricallower limb neurological deficit following spinal anaesthesiawith bupivacaine.

The man, who had a history of ischaemic heart diseaseand type 2 diabetes mellitus, was scheduled to undergototal knee arthroplasty. After insertion of a 25-G needle atthe L4–L5 interspace, he received spinal anaesthesia withinjection of 2.5mL of 0.5% hyperbaric bupivacaine. Thisproduced a satisfactory block, and the procedure wasperformed uneventfully. On his first postoperative day, hedeveloped bilateral paraesthesia of his feet, and by day 2,he could not move his toes. Neurological assessmentrevealed bilateral symmetrical neurological deficit in hislower limbs. Nerve conduction study findings wereconsistent with a pre-existing neuropathy. He wasdiagnosed with subclinical neuropathy.

The man had no functional improvement at his 6-monthpostoperative follow-up visit. Tests showed bilateralcomplete denervation in his tibialis anterior muscles. Hereceived conservative treatment, and was referred forneurorehabilitation.

Author comment: "Patients with longstandingcomorbidities such as peripheral vascular disease or diabetesmellitus may be at an increased risk of further neurologicalinjury from a secondary insult at another site. This double-crush phenomenon has been attributed to factors such asmechanical (needle trauma), ischemic (epinephrine-inducedvasoconstriction), and toxic (local anesthetic neurotoxicity)."Angadi DS, et al. Subclinical neuropathy in diabetic patients: a risk factor forbilateral lower limb neurological deficit following spinal anesthesia?. Journal ofAnesthesia 26: 107-10, No. 1, Feb 2012 - United Kingdom 803075922

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Reactions 25 Aug 2012 No. 14160114-9954/10/1416-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved