Extradural air as a cause of paraplegia following lumbar analgesia.

A 52-year-old woman with chronic back pain presented for lumbar extradural analgesia. The 'loss of resistance to air' technique was used to locate the extradural space. Prolonged paraesthesia and paresis of left leg occurred following the procedure. Urgent lumbar computed tomography scan revealed nerve root displacement due to extradural air.

Continuous extradural infusion of lignocaine 0.75% vs bupivacaine 0.125% in primiparae: quality of analgesia and influence on labour.

We studied 86 primiparous women with uncomplicated pregnancy and labour requesting extradural analgesia in labour. All the women were over 36 weeks of gestation with a cephalic-presenting singleton fetus. The women were allocated randomly to two groups: group A, who received an extradural infusion of lignocaine 0.75%, after an initial dose of 10 ml of lignocaine 1.5%, and group B, who received an infusion of bupivacaine 0.125% after an initial dose of 10 ml of bupivacaine 0.25%. All the women had their labour actively managed. Assessment of analgesia during labour and delivery, and the requirements for additional top-ups were noted, as were mode of delivery, requirement for oxytocic augmentation and incidence of fetal distress. Maternal and umbilical cord plasma concentrations of lignocaine were measured at delivery in 12 women receiving extradural lignocaine. There were no statistically significant differences between the two groups in terms of the mode of delivery, incidence of fetal distress, fetal heart rate abnormalities, or Apgar scores of the babies. Women in the bupivacaine group had a significantly better quality of analgesia during both the first and second stages of labour (p = 0.0005) and required fewer top-ups than those in the lignocaine group. However, the requirement for oxytocin augmentation during the first and second stages of labour was significantly less in the lignocaine group (p = 0.004). Similarly, the duration of the second stage was shorter compared with the bupivacaine group. In spite of high plasma concentrations of lignocaine, no side effects were noted in either mothers or babies.

A case of prolonged hypotension following intravenous guanethidine block.

A 25-year-old female developed causalgia following a nerve injury in the left hand, and this was treated successfully with a series of intravenous guanethidine blocks. However, after the 13th block, systolic arterial blood pressure decreased to 60 mmHg and remained low (80 mmHg) for one week. Accumulation of guanethidine at the sympathetic nerve ending, resulting in autonomic denervation, might be the underlying mechanism of the prolonged hypotension. Treatment was conservative; however, the use of tricyclic antidepressants and sympathomimetic amines to restore the blood pressure to a normal level can be considered with appropriate caution.