title: Spinal myoclonus after subarachnoid anesthesia with bupivacaine.
abstract: OBJECTIVE
  It is presented in this case report a very rare complication after spinal anesthesia to provide subsidies to the management and therapeutic conduct.
  
  
  METHODS
  This is a 63-year old African-Brazilian patient, ASA I, scheduled for transurethral resection of the prostate (TURP). He underwent subarachnoid anesthesia with bupivacaine (15 mg) without adrenaline. Intercurrences were not observed during puncture, and the patient was positioned for surgery. Soon after positioning the patient, he complained of severe pain in the perineum region followed by involuntary tonic-clonic movements of the lower limbs. The patient was treated with a benzodiazepine to control the myoclonus without response. This episode was followed by significant agitation and the patient was intubated. He was maintained in controlled ventilation and transferred to the Intensive Care Unit. Despite all biochemical and imaging tests performed, an apparent cause was not detected. The medication was not changed and the same batch of anesthetic had been used in other patients that same day without intercurrences.
  
  
  CONCLUSIONS
  After ruling out all possible causes, the diagnosis of spinal myoclonus after spinal anesthesia with bupivacaine was made by exclusion.
authors.affiliation: Disciplina de Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil. joaoabrao@fmrp.usp.br
authors.forename: João
authors.initials: J
authors.lastname: Abrão
authors.forename: Marcelo de Paula
authors.initials: Mde P
authors.lastname: Bianco
authors.forename: Waltuires
authors.initials: W
authors.lastname: Roma
authors.forename: José Eduardo de Souza
authors.initials: JE
authors.lastname: Krippa
authors.forename: Jaime Eduardo
authors.initials: JE
authors.lastname: Hallak
mesh_terms: D000775:Anesthesia, Spinal / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D002045:Bupivacaine / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009207:Myoclonus / Q000209:etiology*; D013116:Spinal Cord
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine