A case of sciatic neuropathy after caesarean section under spinal anaesthesia

Area of Science:

• Neurology
• Anesthesiology
• Obstetrics

Background:

• Spinal anesthesia is commonly used for cesarean sections.
• Patient positioning during surgery is crucial for both maternal and fetal well-being.
• Minimizing aortocaval compression is a standard practice during cesarean delivery procedures.

Observation:

• A healthy parturient developed left sciatic neuropathy post-spinal anesthesia for cesarean section.
• Intraoperative use of a wedge for left pelvic tilt to minimize aortocaval compression was noted.
• Postoperative symptoms included inability to move the left foot and left lower leg paresis.

Findings:

• Electromyography confirmed denervation potentials in muscles innervated by the left sciatic nerve.
• The patient experienced a complete recovery from the sciatic nerve injury within seven weeks.
• The findings suggest a link between prolonged lateral tilt and sciatic nerve compression neuropathy.

Implications:

• Prolonged lateral tilt positioning during cesarean sections may pose a risk of sciatic nerve injury.
• Adjusting patient positioning, such as shortening the duration of lateral tilt or returning to a supine position sooner, could mitigate this risk.
• This case highlights the importance of careful patient positioning to prevent iatrogenic nerve injuries in obstetric anesthesia.