Transient obturator neuropathy due to local anesthesia during transobturator sling placement

The transobturator tape procedure is a popular minimally invasive procedure to treat stress urinary incontinence. A 42-year-old woman with stress urinary incontinence underwent a transobturator sling under intravenous sedation and local injection with a mixture of 0.5% bupivicaine and 1% lidocaine with 1:200,000 epinephrine. After surgery, she had difficulty with adduction of the left leg, consistent with a left obturator neuropathy, which improved after approximately 12 h and completely resolved by the next day. Although the transobturator tape is an effective, minimally invasive procedure that may be performed on an outpatient basis, caution should be used in the dosage, type, and amount of local anesthesia used. Post-operative obturator paralysis can be expectantly managed as the symptoms should resolve after the local anesthesia wears off.