Transient neurological symptoms following spinal anesthesia for cesarean section

Transient neurological symptoms (TNS) are defined as symmetrical bilateral pain in the back or buttocks or pain radiating to the lower extremities after recovery from spinal anesthesia. About 80-85% of cesarean sections are performed under spinal anesthesia in our centre. Our aim was to determine the incidence of TNS, risk factors and outcome of management in pregnant women undergoing cesarean section.

Approval was obtained from the hospital ethic's committee, and consent from the patients. ASA 1 and 2 pregnant women undergoing cesarean section under spinal anesthesia formed the subjects of this prospective study. They were evaluated and pre-medicated by the attending anesthetists. Spinal anesthesia was performed at the L2-3 or L3-4 interspaces, using a 25G Quincke or 25G pencil point spinal needle with 0.5% heavy bupivacaine. The investigators interviewed the patients in the ward for three consecutive days, in order to identify those that developed TNS.

One hundred and twenty consecutive patients were studied. TNS were documented in 12 (10%) patients. Backache was recorded in 8 patients (6.6%), pain in the thighs in 2 (1.7%) and pain in the buttocks in 2 (1.7%). Onset time of symptoms was recorded as 6-12 hrs in 5 (4.2%) patients, 12-24 hrs in 5 (4.2%) and 24-48 hrs in 2 (1.6%). The patients that developed TNS were managed accordingly with satisfactory outcome.

A follow-up for all patients that receive spinal anesthesia for cesarean section should constitute a standard practice.