Reactions 1422 - 6 Oct 2012

Bupivacaine/fentanyl

Transient aphonia and facial tingling followingintrathecal administration: case report

A 31-year-old pregnant woman developed transientaphonia and facial tingling following intrathecaladministration of bupivacaine and fentanyl for spinalanaesthesia during caesarean section.

The woman was admitted at 37 weeks’ gestation withtenderness at the site of her previous caesarean sectionscar. Due to the possibility of uterine rupture an urgentcaesarean section was performed. Bupivacaine 7.5mg(1.5mL of 0.5% hyperbaric bupivacaine) and fentanyl 25µgwere administered via intrathecal injection to achieve levelT4 sensory block. A healthy female baby with normal Apgarscore was delivered. Subsequently, 13 minutes afteradministration of bupivacaine and fentanyl, the womanexperienced voice weakness and a tingling sensation overher face, immediately followed by complete inability tospeak. Rostral spread of bupivacaine and fentanyl to thecerebral cortex affecting the speech area or the cranialnerves was suspected.

Sensory block was reassessed and found to be fixed atthe T4 level. The woman’s aphonia resolved after20 minutes and the remainder of the surgery wasuneventful. Postoperative neurological examinationrevealed normal higher function and normal cranial nervefunction with no sensory-motor abnormality.

Author comment: "We describe a case of transientaphonia and facial tingling after spinal anesthesia withbupivacaine-fentanyl for cesarean section".Ray BR, et al. Intraoperative neurological event during cesarean section underspinal anesthesia with fentanyl and bupivacaine: Case report and review ofliterature. Journal of Anaesthesiology Clinical Pharmacology 28: 374-377, No. 3,Jul-Sep 2012. Available from: URL: http://dx.doi.org/10.4103/0970-9185.98349 -India 803077453

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