Unilateral Spinal Anesthesia in a Repeat Cesarean Delivery: A Case Report

Area of Science:

• Anesthesiology
• Obstetrics
• Neurosurgery

Background:

• General anesthesia poses increased risks for mother and infant during cesarean delivery.
• Failed or asymmetric blocks may necessitate urgent general anesthesia.
• True one-sided spinal anesthesia is a rare complication, poorly documented in medical literature.

Purpose of the Study:

• To report a rare case of unilateral spinal anesthesia during cesarean delivery.
• To discuss the potential causes and management of such an event.
• To emphasize the role of anatomical factors in neuraxial block outcomes.

Main Methods:

• Case report of a 32-year-old multiparous woman undergoing elective repeat cesarean delivery.
• Administration of spinal anesthesia followed by epidural rescue for unilateral block.
• Documentation of patient's response to anesthetic interventions and postoperative course.

Main Results:

• Patient developed a complete left-sided sensory and motor block after spinal anesthesia, with no effect on the right.
• Supplemental epidural catheter placement with lidocaine and fentanyl achieved bilateral surgical anesthesia.
• The procedure and postoperative recovery were uneventful.

Conclusions:

• Structurally confined subarachnoid spaces may lead to true one-sided spinal anesthesia.
• Prompt recognition and epidural rescue are effective in managing unilateral spinal blocks.
• Anatomical considerations are crucial when evaluating neuraxial block failures, especially in patients with prior spinal procedures.