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Published on: August 30, 2020
Back pain and collapse associated with receding subarachnoid blockade
M M Coleman1, A Bardwaj, V V Chan
1University of Toronto, Department of Anesthesia, The Toronto Hospital, Ontario, Canada. margaretcoleman@sprint.ca
Severe back pain and loss of consciousness after spinal anesthesia can signal bladder distention. Prompt bladder catheterization relieved symptoms in a case study, highlighting this rare but manageable complication.
Area of Science:
- Anesthesiology
- Urology
- Neurology
Background:
- Spinal anesthesia recovery can present rare complications.
- Back pain and syncope are uncommon during this period.
- Early recognition is crucial to prevent misdiagnosis and ensure proper patient management.
Observation:
- A healthy male volunteer experienced severe back pain and transient loss of consciousness during spinal anesthesia recovery.
- Symptoms occurred as the anesthetic block regressed.
- A significant bladder volume (900 mL) was relieved by catheterization.
Findings:
- Bladder distention can manifest as severe thoracolumbar pain during neuroaxial blockade.
- Sympathetic afferents may mediate referred pain from the bladder.
- The paralysis of sacral parasympathetic nerves prevents the sensation of bladder fullness.
Implications:
- Clinicians must consider bladder distention in patients with unexplained pain and syncope post-spinal anesthesia.
- Effective communication between medical and nursing staff is vital for prompt diagnosis.
- Untreated bladder distention can lead to vasovagal syncope due to excessive parasympathetic outflow.
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