Neurologic Sequelae Following Spinal Anesthesia / 대한마취과학회지

ABSTRACT

Spinal anesthesia is a safe anesthetic technique and relative easy to perform, but occasionally neurologic injuries after spinal anesthesia have been reported. A 53-year old female patient visited the emergency room due to abdominal pain and she was diagnosed with acute appendicitis. Thus, an emergent appendectomy was planned. During the preoperative evaluation, we noticed that she had a history of intermittent low back pain for the previous 5 years. However, because her stomach was not fully empty, we decided to administer spinal anesthesia. When the spinal needle passed the subarachnoid membrane, she suddenly complained of severe paresthesia on her right posterior thigh. However the parethesia subsided soon, and 2.2 cc of 0.5% bupivacaine was injected via a spinal needle, and aftewards, an appendectomy was done without any complications. As she recovered from the spinal anesthesia, she started complaining of shooting, stabbing and burning pain on her right buttock and posterior thigh Because a neurologic injury after spinal anesthesia was suspected, we inserted an epidural catheter to the same lumbar vertebral level for administering the mepivacaine and ketamine mixture and we also performed a right second sacral nerve root block and a lumbar sympathetic ganglion block. Magnetic Resonance Imaging showed spondylosis of lumbar spine and associated disc degeneration and a bulging disc at the L3-4, L4-5 and L5-S1 level. After treatments, her symptoms improved gradually. When she was discharged on the 16th hospital day, she complained of only minor discomfort on her right posterior thigh.