[Transient neurological syndrome after spinal hyperbaric bupivacaine: a new case]

A 47-year-old woman underwent hysteroscopy and removal of an endometrial polyp because of irregular, acyclic bleeding of 6 months' duration. The procedure was carried out under spinal anesthesia. No adverse events occurred during puncture or surgery, or in the immediate postoperative recovery period. Recovery from the sensory and motor block was normal. Twenty-four hours after surgery gluteal and lower limb pain and paresthesia developed, with no sensory or motor deficit. The symptoms suggested transient neurological syndrome. This syndrome has been defined by pain in the lower limbs, buttocks, thighs and calves after uncomplicated spinal anesthesia and full recovery from the sensorimotor block during the immediate postoperative period (first 24 hours). The condition is self-limiting and does not leave permanent neurological sequelae. Recent studies have demonstrated biochemical and anatomical changes that provide a structural basis for this clinical entity. According to this literature, transient neurological syndrome might be a mild expression of local anesthetic toxicity. Recent findings show that the initial injury to the nerve cell membrane, induced by high concentrations of local anesthetic could lead to permanent neuronal damage.