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A transient neurological deficit following intrathecal injection of 1% hyperbaric bupivacaine for unilateral spinal anaesthesia

Published online by Cambridge University Press:  16 August 2006

A. Casati
Affiliation:
Department of Anaesthesiology, University of Milan, IRCCS H San Raffaele, via Olgettina 60, 20132 Milan, Italy
G. Fanelli
Affiliation:
Department of Anaesthesiology, University of Milan, IRCCS H San Raffaele, via Olgettina 60, 20132 Milan, Italy
G. Aldegheri
Affiliation:
Department of Anaesthesiology, University of Milan, IRCCS H San Raffaele, via Olgettina 60, 20132 Milan, Italy
M. Berti
Affiliation:
Department of Anaesthesiology, University of Milan, IRCCS H San Raffaele, via Olgettina 60, 20132 Milan, Italy
A. Leoni
Affiliation:
Department of Anaesthesiology, University of Milan, IRCCS H San Raffaele, via Olgettina 60, 20132 Milan, Italy
G. Torri
Affiliation:
Department of Anaesthesiology, University of Milan, IRCCS H San Raffaele, via Olgettina 60, 20132 Milan, Italy
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Abstract

We describe a case of transient neurological deficit that occurred after unilateral spinal anaesthesia with 8 mg of 1% hyperbaric bupivacaine slowly injected through a 25-gauge pencil-point spinal needle. The surgery and anaesthesia were uneventful, but 3 days after surgery, the patient reported an area of hypoaesthesia over L3–L4 dermatomes of the leg which had been operated on (loss of pinprick sensation) without reduction in muscular strength. Sensation in this area returned to normal over the following 2 weeks. Prospective multicentre studies with a large population and a long follow-up should be performed in order to evaluate the incidence of this unusual side effect. However, we suggest that a low solution concentration should be preferred for unilateral spinal anaesthesia with a hyperbaric anaesthetic solution (if pencil-point needle and slow injection rate are employed), in order to minimize the risk of a localized high peak anaesthetic concentration, which might lead to a transient neurological deficit.

Type
Case Report
Copyright
1998 European Society of Anaesthesiology

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