Bilateral severe pain at L3-4 after spinal anaesthesia with hyperbaric 5% lignocaine.

We describe a case of transient pain in both legs after spinal anaesthesia with a hyperbaric solution of 5% lignocaine delivered in a single bolus through a 22-gauge Quincke needle. The patient remained in a supine decubitus position throughout surgery and 31 h later pain was referred bilaterally to the L3 and L4 dermatomes.

Pneumocephalus after accidental dural puncture during epidural anesthesia.

BACKGROUND. Pneumocephalus developed in a 45-year-old woman after epidural anesthesia was performed to treat her low back pain. The cause was thought to be the loss of resistance to air technique. The clinical symptoms were immediate headache independent of posture, pallor, bradycardia, and hypotension. These symptoms disappeared during the first 24 hours with no neurologic sequelae. CONCLUSION. This case suggests that using the loss of resistance technique with saline versus air should prevent this complication, especially after unintentional dural puncture or when, in difficult placements, the technique is repeated frequently in the same patient.

[Periorbital hematoma as a complication of posterior peribulbar anesthesia]. / Hematoma periorbitario como complicación de la anestesia peribulbar posterior.

We report a case of a large periorbital hematoma which furtherly extended to the ipsilateral orbit and appeared after posterior peribulbar blockade in a 70-year-old woman undergoing cataract extraction and intraocular implant. Peribulbar blockade was carried out with a 23-gauge blunt bevel Atkinson's needle introduced at the level of nasal or internal angle of the upper lid without loosing contact with the ceiling of the orbit. Anesthetic solution was bupicavaine at 0.75% with 10 U/ml of hyaluronidase, 3 ml. Usual blockade of lower lid was not carried out as with the first blockade, an almost complete paresis of extraocular muscles together with discrete conjunctival ecchymosis occurred. Ocular compression was conducted with Homan's balloon at 30 mmHg gor 30 minutes. Then, the eyeball was decompressed and a progressive increase of edema with conjunctival hemorrhage becoming bilateral was observed. Coagulation tests were normal. The incidence of conjunctival ecchymosis and palpebral hematoma with such technique ranges from 2% to 9%; it does not represent any intraoperative problem but may difficult surgery.

[Spinal cord ischemia in the postoperative period of aortic surgery]. / Isquemia medular en el postoperatorio de cirugía aórtica.

Paraplegia is a fearful and not uncommon complication of aortic clamping in surgical procedures involving thoracic and abdominal aorta. We report a case of transient spinal cord ischemia during the early postoperative period of aortobifemoral bypass in a 69-year-old male with arteriosclerosis obliterans, hypertension, type II diabetes mellitus and COLD. The anesthetic procedure was combined (peridural + intubation and mechanical ventilation + isofluorane). Two hypotensive episodes of about 80 mmHg developed, one after induction and another in the Reanimation area. The first one had a short duration, whereas the second one required the administration of colloids, crystalloids and blood. The infrarenal aortic clamping time was 35 minutes. In the early postoperative period the patient had clinical features consistent with spinal ischemia, which progressively recovered. To prevent spinal ischemia during surgery a shorter duration than 30 minutes of aortic clamping, a higher distal perfusion pressures higher than 60 mmHg during clamping, and the attempt to exclude the least possible number of intercostal and/or lumbar vessels are recommended. Drugs (corticosteroids, naloxone) and hypothermia can be useful.

Percutaneous anterior approach to the coeliac plexus using ultrasound.

A new approach is described to the neurolytic block of the coeliac plexus through the anterior abdominal wall using ultrasonic guidance. In nine patients, ultrasound was used for needle placement and examination of the spread of injection. Total pain relief was obtained in seven of the patients after 2 weeks and in five patients after 6 months. No serious complications were observed. The anterior approach is simple and useful in those patients with chronic pancreatic pain undergoing biopsy of the pancreas, and in those terminally ill or heavily sedated patients who have difficulty in tolerating the prone flexed position.

Bilateral interpleural injection of local anesthetics.

Two cases of bilateral interpleural analgesia using bupivacaine are presented. This technique was selected due to relative or absolute contraindications to continuous thoracic epidural analgesia in both cases. Emphasis is placed on the safeguards that need to be employed to avoid the very serious potential complications when this method is employed bilaterally.