///2018 Abstract Details
2018 Abstract Details2018-06-13T16:46:08+00:00

Two cases of sacral numbness after spinal anesthesia for caesarean section

Abstract Number: F3D-8
Abstract Type: Case Report/Case Series

Emma Wilson MB BCh BAO FRCA1 ; Colin Winter MBBCh2

Introduction: The majority of anesthetics for cesarean

section are now delivered using regional techniques.

Thankfully, the risk of nerve injury following insertion of a

central neuraxial block is low. Nevertheless, when a patient

presents with symptoms of a spinal nerve lesion following an

anesthetic they should be adequately assessed and followed

up. We present two cases that prompted change in this in our department.

Case reports: Patient A was a fit and well 38 year old,

with numbness across both buttocks following spinal

anesthesia for cesarean section. She had altered sensation

to temperature and light touch at the level of the sacroiliacs. Pinprick sensation was preserved. She denied any new

bladder or bowel disturbance. She reattended two weeks later

with no resolution of her symptoms despite optimised

analgesia and physiotherapy. An urgent MRI scan did not

reveal any space-occupying lesion to explain her symptoms. A Consultant Neurologist's opinion is

that this may represent some minor trauma or irritiation to the

dorsal nerve roots although he does acknowledge that this is

uncommon.

Patient B was a 30 year old who, similarly, complained

of numbness across her lower back and buttocks after spinal

anesthesia for cesarean section. Her spinal was technically

difficult to perform and required multiple attempts by a

Consultant Anesthetist. She was otherwise well apart from

being a gestational diabetic. She had reduced sensation to

pinprick and temperature at S3 and S4 dermatomes bilaterally

and her right hip flexion was slightly weak compared to the

left. She was otherwise neurologically intact. Again, she was

referred for a Neurology opinion and an urgent MRI was

performed. This was normal. The suggestion in this

case was that these symptoms may represent some nerve root

irritation or that they could be arising from the shift in neural

structures that can be seen in the postpartum period.

Discussion: Similar cases have been reported after the use of

intrathecal hyperbaric bupivacaine, which both of these

ladies received. This may be an emerging pattern that requires

further study. These cases also prompted a discussion within

the department about how such patients are managed. It was

obvious that they were at high risk of being lost to follow-up.

A uniform and agreed approach was needed. This was the

impetus for the development of the Trust guideline that we

now have in place. It means that postpartum patients with

suspected spinal nerve injury have a well-defined pathway

allowing them access to investigations and referral for a

Neurology opinion.

References:

1. McGlennan A, Mustafa A. General anaesthesia for caesarean

section.CEACCP 2009; 9(5), 148–151

2. Boyce H. Post-natal neurological problems. CEACCP 2013; 13

(2),63 –66

3. Paech MJ. Unexplained neurologic deficit after uneventful combined

spinal and epidural anesthesia for cesarean delivery. Reg Anesth

1997; 22(5), 479 -82

SOAP 2018