title: Transient neurologic syndrome after spinal anesthesia with epidural steroid treatment.
abstract: BACKGROUND
  Transient neurologic syndrome (TNS) is a rare complication of spinal and epidural anesthesia. It is defined as paradoxic postoperative back pain radiating to the lower extremities with no neurologic deficits. Because it is a self-limited disease, the treatment is usually symptomatic and consists of NSAIDs and injections of a neuromuscular-blocking drug at the trigger points. The syndrome may be resistant to this treatment regimen and may last for several months, resulting in a long convalescence.
  
  
  METHODS
  A 63-year-old Turkish woman (height, 165 cm; weight, 71 kg) underwent hemorrhoidectomy in the jackknife position using spinal anesthesia. No adverse events occurred during puncture or surgery or in the immediate postoperative recovery period. Recovery from the sensory and motor block was normal. Twenty-four hours after surgery, lower limb and plantar pain developed with no sensory or motor deficit. Neurologic examination revealed normal motor and sensory function. Electroneuromyography showed partial denervation potential of muscles innervated by the left sciatic nerve. The symptoms were suggestive of TNS. Combination oral NSAID treatment with amitriptyline (25 mg/d) and gabapentin (1200 mg/d) was initiated. Because the pain still persisted 6 weeks after surgery, epidural steroid injection with triamcinolone acetate (80 mg) with isotonic saline was administered, resulting in definite pain relief (visual analog scale score = 0).
  
  
  CONCLUSIONS
  Epidural steroid treatment was effective in this patient with TNS resistant to treatment with NSAIDs, amitriptyline, and gabapentin. Future studies are needed to evaluate this treatment.
authors.affiliation: Department of Anesthesiology, Gaziantep University, Gaziantep, Turkey.
authors.forename: L Pirbudak
authors.initials: LP
authors.lastname: Cöcelli
authors.affiliation: Department of Neurosurgery, Gaziantep University, Gaziantep, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Erkutlu
authors.affiliation: Department of Orthopedics, Gaziantep University, Gaziantep, Turkey.
authors.forename: Gunhan
authors.initials: G
authors.lastname: Karakurum
authors.affiliation: Department of Anesthesiology, Gaziantep University, Gaziantep, Turkey.
authors.forename: Neslihan
authors.initials: N
authors.lastname: Avci
authors.affiliation: Department of Anesthesiology, Gaziantep University, Gaziantep, Turkey.
authors.forename: Rauf
authors.initials: R
authors.lastname: Gül
authors.affiliation: Department of Anesthesiology, Gaziantep University, Gaziantep, Turkey.
authors.forename: Unsal
authors.initials: U
authors.lastname: Oner
keywords: analgesia; anesthesia; epidural; neurologic; postoperative complications; spinal