Spinal anaesthesia in a patient with hereditary spastic paraplegia: case report and literature review.
We report the use of spinal anaesthesia in a patient with hereditary spastic paraplegia who presented for manual removal of placenta following a normal vaginal delivery. This 18-year-old primigravida had been diagnosed with hereditary spastic paraplegia at 8 years of age when neurological examination revealed mild bilateral lower limb spasticity. A 25-gauge Whitacre spinal anaesthetic needle was inserted at the L3-4 intervertebral space and 0.5% plain bupivacaine 2 mL plus fentanyl 25 microg administered. The procedure was uneventful. At 24 hours postoperatively, there was full neurological recovery to pre-anaesthetic levels. The hereditary spastic paraplegias are a group of neurological disorders characterised by a slowly progressing spastic paraparesis. The neurological disorder and its anaesthetic implications are reviewed.
Thomas
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Department of Obstetric Anaesthesia, St Michael's Hospital, Bristol, UK. Thmsia@aol.com
Thomas
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Scrutton
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D000293:Adolescent; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D005113:Extraction, Obstetrical / Q000379:methods; D005260:Female; D006801:Humans; D018457:Placenta, Retained / Q000628:therapy*; D011247:Pregnancy; D015419:Spastic Paraplegia, Hereditary