DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20211929

Neuroaxial anesthesia caused paraplegia: a case report

Luis David Cortés-Badillo, Agustín Reyes-Gutiérrez, Óscar Gómez-Chaccón, Luis David Olivera-León, Elsy Daniela Olivera-León, Juan José Granados-Romero, Baltazar Barrera-Mera, Rodrigo Banegas-Ruiz, José Juan Vargas-Morales, Elvira Barrera-Calva, Francisco Fabián Gómez-Mendoza, Carlos Rubén Baca-Domínguez, Emilio Pérez Ortega, Rodrigo A. Mendoza-Aceves, Mariana del Carmen Radilla-Flores, Nelson Niels Espinosa Queb, Alejandro Ángel Corona Figueroa, Bruno Andrés Salazar Trujillo, Mario Gutiérrez-Hernández, Alan Isaac Valderrama-Treviño

Abstract


Patients who undergo; anesthesia, neuraxial analgesia, or some type of neuraxial blockage are exposed to multiple complications. 33-year-old male patient, suffers a femur fracture with a long oblique trace causing pain and functional limitation for movements. Surgical resolution is determined using neuraxial block at L2-L3 level, and intravenous sedation. During his postoperative follow-up, a decrease in strength was confirmed in the lower limbs with 0/5 on the Daniels scale, 100% sensitivity without sphincter control, steroids were prescribed along with magnetic resonance imaging and a neurosurgical evaluation was requested. The MRI shows bulging of the fibrous annulus that obliterates the epidural fat and makes contact with the thecal sac in the L5-S1 intervertebral disc level. The neurosurgery service prescribes rehabilitation sessions at home, electrostimulation and neuropathic medications. Patient was discharged with rehabilitation sessions at home and medical treatment. In his last consultation, an evaluation from the psychiatry department was requested for ideas of disability, hopelessness, fantasies of death without a suicide plan related to limitations and loss of functionality. Patient does not return to external follow-up, cannot be located.


Keywords


Neuroaxial anesthesia, Paraplegia, Neuraxial block, Neuraxial anesthesia complications, Spinal cord injuries, Non-reversible paraplegia

Full Text:

PDF

References


Whizar-Lugo VM, Flores-Carrillo J.C. Complicaciones Neurológicas de la Anestesia Neuroaxial. Anestesia en México. 2006;18(3):133-44.

Whizar LV, Carrada PS. Anestesia subaracnoidea. Cien años después. Rev Mex Anest. 1999;22:1-4.

Wong CA. Nerve injuries after neuraxial anaesthesia and their medicolegal implications. Best Practice & Research Clinical Obstetrics and Gynaecology. 2010;24(2010):367-81.

Jedsadayoot S, Arpakorn K, Preeyaphan A. Paraplegia Following Obstetric Spinal Anesthesia: A Case Report. Biomed J Sci & Tech Res. 2019;19(2):14229-31.

Auroy Y, Benhamou D, Bargues L, Ecoffey C, Falissard B. Major complications of regional anaesthesia in France: the SOS regional anaesthesia hotline service. Anesthesiology. 2002;97:1274-80.

Molina GMB, Borraz LP, Jose G-OL, Ramirez-Fernandez A, Aliaga RM, Juan E-BJ et al. Neuraxial Anaesthesia Complications. Medical & Clinical Reviews. 2015;1(4):1-7.

Hebl J. The importance and implications of aseptic techniques during regional anesthesia. Regional Anesthesia and Pain Medicine. 2006;31:311-23.

Wedel D, Horlocker T. Regional anesthesia in the febrile or infected patient. Regional Anesthesia and Pain Medicine. 2006;31:324-33.

Hewson DW, Bedforth NM, Hardman JG. Spinal cord injury arising in anaesthesia practice. Anaesthesia. 2018;73(1):43-50.

Domínguez-Gasca LG, Sandoval-Larios CG, López-Alcalá LA, Hasslacher-Arellano JF, Mora-Constantino J, Domínguez-Carrillo LG. Lesión del cono medular durante anestesia espinal: un diagnóstico clínico-radiológico. Acta Médica Grupo Ángeles. 2014;12(3):141-5.

Brown RA. Nerve damage following central neuraxial blockade: Is it avoidable? Rev Mex Anest. 2008;31(1):s56-61.

Horlocker TT, McGregor DG, Matsushige DK, Schroeder DR, Besse JA. A retrospective review of 4,767 consecutive spinal anesthetics: central nervous system complications. Perioperative Outcomes Group. Anesth Analg. 1997;84:578-84.

Auroy Y, Narchi P, Messiah A, Litt L, Rouvier B, Samii K. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology. 1997;87:479-86.

Auroy Y, Benhamou D, Bargues L, Ecoffey C, Falissard B, Mer- cier FJ et al. Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Ser- vice. Anesthesiology. 2002;97:1274-80.

Loo CC, Dahlgren G, Irestedt L. Neurological complications in obstetric regional anaesthesia. International Journal of Obstetric Anesthesia. 2000;9(2):99-124.

Conroy PH, Luyet C, McCartney CJ, McHardy PG. Real-time ultrasound-guided spinal anesthesia: a prospective observational study of a new approach. Anesthesiol Res Pract. 2013;2013:525818.

Sage DJ. Major neurological injury following regional anaesthe- sia, Complications of Regional Anesthesia. Edited by Finucane BT. Philadelphia, USA, Churchill Livingstone. 1999: 257-269.