Obstetrik hastada spinal ropivakainin geçici nörolojik komplikasyonu

Spinal anestezi sonrası geçici nörolojik semptomları bildirmeyi ve bölgesel anestezinin postpartum nörolojik sorunlarını gözden geçirmeyi amaçladık. 25 yaşında, sağlıklı primigravid bir kadına elektif sezaryen uygulandı. Ameliyat sırasında hipotansiyon ve bradikardi görülmedi. Sezaryenden sonraki 25. günde hasta, alt ekstremitede hissizlik ve halsizlik bildirdi. Nörolojik değerlendirmede, bilateral olarak gastrokinemius ve kuadriseps kas gücü sırasıyla 2/5 (+) ve 3/5 (+) idi. Ayak dorsifleksiyonu ve plantar fleksiyondaki kas gücü 2/2 (+) bilateral idi. Hasta ayak parmakları üzerinde yürüyemedi, topuklar üzerinde yürüdü ve alt ekstremiteler hipoestezikti. Patellar ve aşil tendonu refleksleri bilateral olarak negatiftir. Lumbosakral MRG’de patolojik bulgu saptanamamıştır. EMG’de karışık tipte bir polinöropati görüldü. Semptomlar kısmen ikinci ayın sonunda hafiflemiş ve üçüncü ayın sonunda tamamen gerilemiştir. Sonuç olarak, doğum sonu geri dönüşümsüz, kalıcı nörolojik defisitlerin önlenmesi için, MRG veya BT ile birlikte yapılan nörolojik muayene ile tanı konulmalıdır.

Temporary neurologic complication of spinal ropivacaine in an obstetric patient

We aimed to inform transient neurological symptoms after spinal anesthesia and to review postpartum neurological deficits of regional anesthesia. A previously healthy 25-year-old primigravid woman underwent an elective cesarean section. Hypotension and bradycardia were not observed during the operation. On the 25th day postpartum, the patient suffered from numbness and weakness at the lower extremity. On neurological assessment, the muscle strengths in the gastrocnemius and quadriceps bilaterally were 2/5 (+) and 3/5 (+), respectively. The muscle strength at foot dorsiflexion and plantar flexion were 2/5 (+) bilaterally. The patient was unable to walk on toes and walked on heels, and the lower extremities were hypoesthetic. The patellar and the Achilles tendon reflexes were bilaterally negative. No pathological findings could be detected on lumbosacral magnetic resonance imaging (MRI). Electromyography revealed a mixed type of polyneuropathy. The symptoms relieved partially at the end of the $2^{nd}$ month and regressed completely at the end of the $3^{rd}$ month. To prevention of irreversible postpartum permanent neurologic deficits, the diagnosis should be made using a detailed neurologic examination along with MRI or computed tomography.

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