title: A transient neurological deficit following intrathecal injection of 1% hyperbaric bupivacaine for unilateral spinal anaesthesia.
abstract: We describe a case of transient neurological deficit that occurred after unilateral spinal anaesthesia with 8 mg of 1% hyperbaric bupivacaine slowly injected through a 25-gauge pencil-point spinal needle. The surgery and anaesthesia were uneventful, but 3 days after surgery, the patient reported an area of hypoaesthesia over L3-L4 dermatomes of the leg which had been operated on (loss of pinprick sensation) without reduction in muscular strength. Sensation in this area returned to normal over the following 2 weeks. Prospective multicentre studies with a large population and a long follow-up should be performed in order to evaluate the incidence of this unusual side effect. However, we suggest that a low solution concentration should be preferred for unilateral spinal anaesthesia with a hyperbaric anaesthetic solution (if pencil-point needle and slow injection rate are employed), in order to minimize the risk of a localized high peak anaesthetic concentration, which might lead to a transient neurological deficit.
authors.affiliation: Department of Anaesthesiology, University of Milan, IRCCS H San Raffaele, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Casati
authors.forename: G
authors.initials: G
authors.lastname: Fanelli
authors.forename: G
authors.initials: G
authors.lastname: Aldegheri
authors.forename: M
authors.initials: M
authors.lastname: Berti
authors.forename: A
authors.initials: A
authors.lastname: Leoni
authors.forename: G
authors.initials: G
authors.lastname: Torri
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D009422:Nervous System Diseases / Q000139:chemically induced* / Q000503:physiopathology; D019999:Pharmaceutical Solutions
chemical_list: D000779:Anesthetics, Local; D019999:Pharmaceutical Solutions; D002045:Bupivacaine