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[Transient neurologic symptoms after spinal anesthesia with 4% hyperbaric mepivacaine]
B Bang-Vojdanovski1, H Hannibal, M Eberhardt
1Anaesthesieabteilung,Orthopädische Klinik Kassel. Boris.Bang@t-online.de
Abstract:
This is a case report of transient neurologic symptoms (TNS) after spinal anesthesia with 4% hyperbaric mepivacaine,which have not been reported before. The patient was a 44-year-old man with a meniscus lesion who received spinal anesthesia with 80 mg 4% mepivacaine while undergoing knee arthroscopy. A L3-L4 mid-line approach was used with a 26-gauge Quincke needle and a 21-gauge introducer. The local anaesthetic was injected over approximately 30 s with the aperture of the Quincke needle in a cephalad direction. A transient pain syndrome was observed 4 h after spinal anesthesia, which included symmetric pain and/or dysesthesia in the buttocks and posterior thighs appearing 4 h after recovery from the spinal anesthesia and had a duration of 2 days. The patient stated that the pain radiated through the hips, buttocks, and posterior thighs and extended past the buttocks and lower legs. The pain was described as strong and aching,occasionally decreasing when walking around. It responded well to NSAID and resolved spontaneously within 3 days. No other neurologic symptoms or signs were noted.
Insights
Transient neurologic symptoms (TNS) after spinal anesthesia with 4% hyperbaric mepivacaine are reported for the first time. This case involved pain and dysesthesia in the buttocks and thighs, resolving within 3 days.
Area of Science:
- Anesthesiology
- Neurology
- Case Reports
Background:
- Spinal anesthesia is a common procedure for lower limb surgeries.
- Transient neurologic symptoms (TNS) are a known, albeit rare, complication.
- Mepivacaine is a frequently used local anesthetic for spinal anesthesia.
Observation:
- A 44-year-old male patient developed TNS after spinal anesthesia with 4% hyperbaric mepivacaine for knee arthroscopy.
- Symptoms included symmetric pain and dysesthesia in the buttocks and posterior thighs.
- Onset was 4 hours post-anesthesia, with a duration of 2 days.
Findings:
- The patient experienced strong, aching pain radiating to the hips, buttocks, and posterior thighs, extending to the lower legs.
- Pain improved with ambulation and responded well to NSAIDs.
- No other neurological deficits were observed.
Implications:
- This case highlights a previously unreported TNS presentation associated with 4% hyperbaric mepivacaine.
- Further investigation may be warranted to understand the specific mechanisms and risk factors.
- Anesthesiologists should be aware of this potential complication and its management.