Eye problem following foot surgery--abducens palsy as a complication of spinal anesthesia.
BACKGROUND
Paralysis of abducens nerve is a very rare complication of lumbar puncture, which is a common procedure most often used for diagnostic and anesthetic purposes.


METHODS
A 38-year-old man underwent surgery for a left hallux valgus while he was under spinal anesthesia. On the first postoperative day, the patient experienced a severe headache that did not respond to standard nonsteroidal anti-inflammatory medication and hydration. During the second postoperative day, nausea and vomiting occurred. On the fourth postoperative day, nausea ceased completely but the patient complained of diplopia. Examination revealed bilateral strabismus with bilateral abducens nerve palsy. His diplopia resolved completely after 9 weeks and strabismus after 6 months.


CONCLUSIONS
Abducens palsy following spinal anesthesia is a rare and reversible complication. Spinal anesthesia is still a feasible procedure for both the orthopaedic surgeon and the patient. Other types of anesthesia or performing spinal anesthesia with smaller diameter or atraumatic spinal needles may help decrease the incidence of abducens palsy. Informing the patient about the reversibility of the complication is essential during the follow-up because the palsy may last for as long as 6 months. Special attention must be paid to patient positioning following the operation. Recumbency and lying flat should be accomplished as soon as possible to prevent cerebrospinal fluid leakage and resultant intracranial hypotension. This becomes much more important if the patient has postdural puncture headache.
Kose
Kamil Cagri
KC
Department of Orthopaedics and Traumatology, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey. ckose@medscape.com
Cebesoy
Oguz
O
Karadeniz
Engin
E
Bilgin
Sinan
S
D020434:Abducens Nerve Diseases / Q000175:diagnosis* / Q000209:etiology*; D020222:Abducens Nerve Injury / Q000175:diagnosis* / Q000209:etiology*; D000775:Anesthesia, Spinal / Q000009:adverse effects; D004948:Esotropia / Q000175:diagnosis* / Q000209:etiology*; D050488:Hallux Varus / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D013129:Spinal Puncture / Q000009:adverse effects*