ONUR BALABAN, Yavuz GÜRKAN, ALPARSLAN KUŞ, Kamil TOKER, Mine SOLAK

Monoplegia after combined spinal epidural anesthesia

Santral nöroaksiyel bloklarda, kalıcı sinir hasarı gibi ciddi nörolojik komplikasyonlar günümüz anestezi uygulamalarında nadiren görülür. Varis ameliyatı geçirecek olan 36 yaşında kadın hastaya kombine spinal epidural anestezi uygulandı. Anestezi uygulaması ve cerrahi işlem komplikasyonsuz tamamlandı. Alt ekstremitede motor blok çözülene kadar derlenme odasında bekletilen hasta, epidural hasta kontrollü anestezi başlatılarak cerrahi servise gönderlildi. Cerrahiden 10 saat sonra hastanın sağ tarafında monopleji geliştiği görüldü. Epidural kateter çekildi. Hastanın lomber manyetik rezonans görüntülemesinde epidural hematoma rastlanmadı. Bir ay hastanede fizik tedavi ve iki aylık takip sonrası hasta, koltuk değneği ile yürüyebilir hale geldi. Bu olguda radikülopatiye neden olan faktörleri ve nörolojik defisit nedeni olarak nörotoksisiteyi tartışmak istedik.

Kombine spinal epidural anestezi sonrası gelişen monopleji

Serious neurological complications after neuraxial block, including permanent neurological injury, are rare in contemporary anesthetic practice. We report a case of a 36 year old female undergoing a venous stripping operation under combined spinal epidural anesthesia (CSE). The CSE procedure was completed after a second attempt at the L4-L5 level and the surgery was completed uneventfully. After full recovery of motor block in the recovery room, the patient was discharged to the surgical ward. Epidural patient controlled analgesia with levobupivacine 0.125% and fentanyl 2μg/ml was initiated. 10 hours after surgery, right lower limb sensory loss and monoplegia occurred. The epidural catheter was removed and normal MRI findings were noted. After one month of physical therapy treatment and two months follow up the patient was able to walk with the aid of a walking stick. We discuss factors that might have contributed to radiculopathy and neurotoxicity as a cause of neurologic deficit.

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