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Related Experiment Videos

[Severe lightning limb pain induced by spinal anesthesia].

K Osuga1, Y Hirabayashi, H Fukuda

  • 1Department of Anesthesiology, Jichi Medical School, Tochigi.

Masui. the Japanese Journal of Anesthesiology
|February 26, 1999
PubMed
Summary

Spinal anesthesia can cause severe lightning limb pain, even in patients with prior lumbar procedures. This acute pain resolved as the spinal anesthesia effects wore off.

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Area of Science:

  • Anesthesiology
  • Neurology
  • Pain Medicine

Background:

  • A 71-year-old male patient presented for a prostate biopsy.
  • Preanesthetic evaluation revealed pre-existing mild hypesthesia in the L5-S1 dermatomes of the right leg.
  • The patient reported a history of lumbar 'local anesthetic' injection 16 years prior, attributing his current hypesthesia to it.

Observation:

  • Spinal anesthesia was administered uneventfully using a 25 G Quincke needle at the L3-4 interspace with 0.3% hyperbaric dibucaine.
  • Immediately upon repositioning to the supine position, the patient experienced severe, lightning-like pain.
  • The pain was localized to the dermatomal segments previously noted as hypesthetic.

Findings:

  • The administered spinal anesthesia triggered acute, severe neuropathic pain, described as 'lightning limb pain'.

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  • This pain was directly correlated with the area of pre-existing sensory deficit.
  • The intense pain resolved completely within 4 hours, coinciding with the resolution of the spinal anesthesia's effects.

    • Implications:

    • This case highlights a rare but severe adverse event of spinal anesthesia potentially linked to prior lumbar interventions.
    • It suggests a possible interaction between previous anesthetic/analgesic procedures and subsequent spinal anesthesia, leading to neuropathic pain.
    • Further investigation is warranted to understand the mechanisms and risk factors for such paradoxical pain responses following spinal anesthesia.