Reactions 1341 - 5 Mar 2011

SBupivacaine/ropivacaine

Cauda equina syndrome following spinal-epiduralanaesthesia: case report

A 29-year-old woman developed cauda equinasyndrome following intrathecal bupivacaine and epiduralropivacaine for spinal anaesthesia during a caesarean.

The woman received 2.2mL of hyperbaric bupivacaine0.5% into the L3-L4 interspace, and a total dose of 5.1mLropivacaine 0.2% via a patient-controlled epidural deviceover 75 minutes. Following surgery, she did not fullyrecover from the spinal anaesthesia. Additionally, she wasunable to walk due to lower extremity weakness about48 hours post-partum. Sensory deficit to pinprick andvibration in the T3 to L5 region was observed during aneurological assessment. The next day, she still showedbilateral hypaesthesia with lower extremity weakness, butshe did experience a minor improvement. Neurologicalcomplication related to the anaesthetic was thought to bethe most likely cause of her symptoms. Seven dayspostoperatively, she was still unable to walk, void, ordefaecate spontaneously. A contrast-enhanced MRI scanrevealed abnormal enhancement in the cauda equina, andenhancement of the ventral nerve roots at the level ofT12-L1 and L1-L2.

The woman was treated with high-dose corticosteroids,and her symptoms gradually improved. By the end oftreatment, she could walk without assistance. Six monthslater, she still had mild sensory disturbance of the lowerextremities and her pelvic area.Takasu M, et al. Gadolinium enhancement of cauda equina after combined spinal-epidural anaesthesia. British Journal of Radiology 83: e192-e194, No. 993, Sep2010 - Japan 803050286

1

Reactions 5 Mar 2011 No. 13410114-9954/10/1341-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved