Indian Journal of Anaesthesia  
About us | Editorial board | Search | Ahead of print | Current Issue | Past Issues | Instructions
Home | Login  | Users Online: 179  Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size    




 
 Table of Contents    
LETTER TO EDITOR
Year : 2011  |  Volume : 55  |  Issue : 1  |  Page : 78-79  

Foot drop after spinal anaesthesia: A rare complication


Department of Anaesthesia, MVJ Medical College and Research Hospital, Hoskote, Bangalore, Karnataka, India

Date of Web Publication9-Feb-2011

Correspondence Address:
B C Nirmala
No. 191, 4th Main, 2nd Cross, Viveknagar, Bangalore - 560 047
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.76590

Rights and Permissions

How to cite this article:
Nirmala B C, Kumari G. Foot drop after spinal anaesthesia: A rare complication. Indian J Anaesth 2011;55:78-9

How to cite this URL:
Nirmala B C, Kumari G. Foot drop after spinal anaesthesia: A rare complication. Indian J Anaesth [serial online] 2011 [cited 2017 Dec 16];55:78-9. Available from: http://www.ijaweb.org/text.asp?2011/55/1/78/76590

Sir,

We report a case of foot drop following spinal anaesthesia. As such, neurological complications for central neuraxial blocks are less common. At the time of spinal anaesthesia, if the patient complains of pain or paraesthesia, watch these cases postoperatively carefully for any neurological deficit. The most likely cause in our case is neurotrauma.

A healthy 28-year-old adult female was scheduled for diagnostic laparoscopy. She had no other medical comorbidity history. After obtaining informed written consent and after overnight fasting, she was pre-medicated with tab lorazepam 2 mg, tab ranitidine 150 mg and tab ondensetron 4 mg at 6 AM on the day of surgery (3 h before shifting to the operating room).

In the operative room, an intravenous (IV) access was obtained with a 18 g cannula and monitoring with electrocardiogram (ECG), pulse oximetry and non invasive blood pressure (NIBP) were initiated. With all aseptic precautions a 25g Quincke needle was inserted in the L3-L4 interspace. As the needle entered the subarachnoid space, the patient presented a jerky reaction and complained of paraesthesia and pain. Immediately, the needle was withdrawn, following which the pain subsided instantaneously and she was comfortable. A second time, the needle was placed in the L3-L2 interspace uneventfully. There was good cerebrospinal fluid flow and 3 ml of 0.5% bupivacaine with 25 mg of fentanyl [1] were injected. Inj midazolam 1 mg was given intravenously. The laparoscopic procedure lasted for 35 min. Intraoperative hypotension was managed with Inj ephedrine and her haemodynamic values were maintained stable. The patient was lightly sedated and comfortable throughout.

Postoperatively, approximately after 4 h, the patient was ambulated for passing urine. Then, she noticed that she was unable to move her right foot and the left foot was normal. On examination, she had weakness of the right foot. The case was referred to the neurology department. They diagnosed right-sided foot drop (4/5) and started her on steroids nonsteroidal anti-inflammatory drugs (NSAID) and B-complex. Neurological examination was performed every 4th hourly [2],[3] to observe for any progressive weakness. The patient's neurological symptoms were nonprogressive. On the following day, magnetic resonance imaging was performed, which showed no abnormality [Figure 1]. She was discharged with advice of physiotherapy and to continue steroids NSAID and B-complex on the 5 th day.
Figure 1: Normal magnetic resonance imaging

Click here to view


In the follow-up after 4 weeks, she had partial recovery of (3/5) motor power and 8 weeks later, she had complete recovery.

Spinal anaesthesia with opioids provides excellent surgical conditions for short laparoscopic surgeries. [4] During neuraxial blockade, trauma to the nerve roots or spinal cord could be the cause for paraesthesia and pain. Needle trauma or accidental wrong drug placement are the probable causes for neurological complications following spinal anaesthesia.

Nerve conduction studies are useful in the localization and assessment of nerve injury. Electromyography studies are an adjunct to nerve conduction studies. Signs of denervation on the electromyogram (EMG) after acute nerve injury require 18-21 days to develop.

However, the type and extent of nerve injury vary with the orientation of the needle. When the bevel is parallel to the long axis of the nerve, the needle more readily pass between the fibres. When the needle is transverse to the nerve fibre, the injury is greater. [5] Some sensory disturbances and occasional weakness may last for more than a year.

When paraesthesia is elicited as the needle advances, one can be reasonably certain that a nerve root has been struck. Paraesthesia and its intensity may serve as a warning sign and a guide for severity of nerve injury. Never inject any drug when the patient complains of pain, as an intraneural injection is painful and forebodes permanent damage.

 
   References Top

1.Hamber EA, Viscomi CM. Intrathecal lipophlic opioids as adjuncts to surgical spinal anaesthesia. Reg Anesth Pain Med 1999;24:255-63.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Reynold's F. Damage to the conus medullaris following spinal anaesthesia. Anaesthesia 2001;56:238-47.  Back to cited text no. 2
    
3.Auroy Y, Narchi P, Messiah A, Litt L, Rouvier B, Samii K. Serious complications related to regional anaesthesia: Results of a prospective survey in France. Anaesthesiology 1997;87:479-86.  Back to cited text no. 3
    
4.de Santiago J, Santos-Yglesias J, Giron J, Montes de Oca F, Jimenez A, Diaz P. Low dose 3mg levobupivacaine plus 10mg fentanyl selective spinal anaesthesia for gynecological outpatient laparoscopy. Anesth Analg 2009;109:1456-61.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Selander D, Dhuner KG, Lundborg G. Peripheral nerve injury due to injection needles used for regional anaesthesia. An experimental study of the acute effects of needle point trauma. Acta Anaesthesiol Scand 1997;21:182-8.  Back to cited text no. 5
    


    Figures

  [Figure 1]


This article has been cited by
1 Foot drop: an iatrogenic complication of spinal anesthesia
Vipin Kumar Goyal,Vijay Mathur
Brazilian Journal of Anesthesiology (English Edition). 2017;
[Pubmed] | [DOI]
2 Queda do pé após raquianestesia
Ilker Onguc Aycan,Huseyin Turgut,Abdulmenap Guzel,Erdal Dogan,Gonul Olmez Kavak
Brazilian Journal of Anesthesiology. 2015; 65(5): 423
[Pubmed] | [DOI]
3 Homozygous hemoglobin S (HbSS) presenting with bilateral facial nerve palsy: a case report
Babatunde Ogundunmade,Unyime Jasper
BMC Research Notes. 2014; 7(1): 729
[Pubmed] | [DOI]
4 Foot drop following spinal anaesthesia
Ilker Onguc Aycan,Huseyin Turgut,Abdulmenap Guzel,Erdal Dogan,Gonul Olmez Kavak
Brazilian Journal of Anesthesiology (English Edition). 2014;
[Pubmed] | [DOI]
5 Proximal fibular osteochondroma producing common peroneal nerve palsy in a post-cesarean section patient
Manoharan, A. and Suresh, S.S. and Sankaranarayanan, L.
Oman Medical Journal. 2013; 28(3)
[Pubmed]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References
    Article Figures

 Article Access Statistics
    Viewed2033    
    Printed81    
    Emailed2    
    PDF Downloaded434    
    Comments [Add]    
    Cited by others 5    

Recommend this journal