Reactions 1225 - 25 Oct 2008

SBupivacaine/fentanyl

Subdural haematoma after spinal anaesthesia: casereport

A 31-year-old primiparous woman developed subduralhaematoma after receiving spinal anaesthesia withbupivacaine and fentanyl.

The woman, who had presented for an elective caesariandelivery, received 2mL of 0.5% bupivacaine and 10µg offentanyl at L3-L4 interspace with a 25-gauge needle. Duringsurgery, she received oxytocin. Her vital signs remainednormal throughout the perioperative period. However,48 hours after surgery, she developed moderate and persistentright headache along with right retro-orbital pain.

The woman’s pain did not improve after treatment withnonsteroidal anti-inflammatories and, 2 hours later, shedeveloped drowsiness and a progressive decrease in herconsciousness level. Her Glasgow Coma Scale (GCS) scorewas 8. She had marked right hemiplegia and anisocoria. ACT scan revealed a right temporoparietal subdural haematomawith midline displacement and mass effect. She subsequentlyunderwent a right frontotemporal craniotomy and haematomawas evacuated; surgery was performed under generalanaesthesia with fentanyl, propofol and suxamethoniumchloride [succinylcholine chloride] induction, and propofol,cisatracurium besilate and remifentanil maintenance. After twodays, she was extubated. A neurological examination revealeda GCS score of 15 along with right lower extremity paresis andcranial nerve III paralysis. She was subsequently dischargedwith minimal weakness of the right lower extremity.Ramos-Aparici R, et al. Acute subdural hematoma after spinal anesthesia in anobstetric patient. Journal of Clinical Anesthesia 20: 376-378, No. 5, Aug 2008 -Spain 801124271

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Reactions 25 Oct 2008 No. 12250114-9954/10/1225-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved