Unexplained neurologic deficit after uneventful combined spinal and epidural anesthesia for cesarean delivery.

BACKGROUND AND

OBJECTIVES

Neurologic deficits after spinal and epidural anesthesia are uncommon and have a variety of pathophysiologic mechanisms. Local anesthetic neurotoxicity may occur, although subarachnoid bupivacaine has an unblemished clinical record.

METHODS

A healthy parturient underwent uneventful combined spinal and epidural anesthesia for elective cesarean delivery. Intraspinal drugs administered included hyperbaric bupivacaine 0.5% and fentanyl (subarachnoid) and 2% lidocaine with epinepherine 1:200,000 and meperidine (epidural).

RESULTS

On the third postpartum day the patient reported buttock numbness. An area of hypoesthesia in the distribution of the lower sacral nerves was present, without systemic or other neurologic symptoms and signs. The deficit persisted, and imaging of the lower spinal canal revealed no significant abnormality. Full recovery of sensation occurred after 7 months.

CONCLUSION

Drug-induced neurotoxicity is a possible explanation, although the exact etiology is uncertain.