Foot drop: an iatrogenic complication of spinal anesthesia

Vipin Kumar Goyal; Vijay Mathur

doi:10.1016/j.bjane.2017.09.006

Clinical Information

Foot drop: an iatrogenic complication of spinal anesthesia

Pé caído: uma complicação iatrogênica da anestesia espinhal

Vipin Kumar Goyal; Vijay Mathur

http://dx.doi.org/10.1016/j.bjane.2017.09.006 Braz J Anesthesiol, vol.68, n4, p.412-415, 2018

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Abstract

Abstract Background and objectives Foot drop in postoperative period is very rare after spinal anesthesia. Early clinical assessment and diagnostic interventions is of prime importance to establish the etiology and to start appropriate management. Close follow-up is warranted in early postoperative period in cases when patient complain paresthesia or pain during needle insertion or drug injection. Case report A 22-year-old male was undergone lower limb orthopedic surgery in spinal anesthesia. During shifting from postoperative ward footdrop was suspected during routine assessment of regression of spinal level. Immediately the patient was referred to a neurologist and magnetic resonance imaging was done, which was inconclusive. Conservative management was started and nerve conduction study was done on the 4th postoperative day that confirmed pure motor neuropathy of right peroneal nerve. Patient was discharged with ankle splint and physiotherapy after slight improvement in motor power (2/5). Conclusions Foot drop is very rare after spinal anesthesia. Any suspected patient must undergo emergent neurological consultation and magnetic resonance imaging to exclude major finding and need for early surgical intervention.

Keywords

Spinal anesthesia, Paresthesia, Magnetic resonance imaging, Physiotherapy

Resumo

Resumo Justificativa e objetivos Pé caído no período pós-operatório é muito raro após a anestesia espinhal. Avaliação clínica e intervenções diagnósticas precoces são de primordial importância para estabelecer a etiologia e iniciar o tratamento adequado. Um acompanhamento atento é justificado no pós-operatório imediato nos casos em que o paciente se queixa de parestesia ou dor durante a inserção da agulha ou da injeção de fármacos. Relato de caso Paciente do sexo masculino, 22 anos, submetido a cirurgia ortopédica de membros inferiores sob anestesia espinhal. Durante a transferência para a sala de recuperação pós-operatória, houve suspeita de pé caído durante a avaliação rotineira da regressão do nível espinhal. O paciente foi imediatamente enviado ao neurologista e uma ressonância magnética foi feita, mas não foi conclusiva. O manejo conservador foi iniciado e o estudo de condução nervosa foi feito no 4° dia de pós-operatório, o que confirmou a neuropatia motora pura do nervo fibular direito. O paciente foi dispensado com imobilizador de tornozelo e fisioterapia após ligeira melhoria da força motora (2/5). Conclusões Pé caído é muito raro após a anestesia espinhal. Qualquer paciente suspeito deve ser submetido à consulta neurológica de emergência e ressonância magnética para excluir o principal achado e a necessidade de intervenção cirúrgica precoce.

Palavras-chave

Anestesia espinhal, Parestesia, Imagem de ressonância magnética, Fisioterapia

References

Scott DB, Tunstall ME. Serious complications associated with epidural/spinal blockade in obstetrics: a two-year prospective study. Int J Obstet Anesth. 1995;4:133-9.

Auroy Y, Benhamou D, Bargues L. Major complications of regional anesthesia in France. Anaesthesiology. 2002;97:1274-80.

Kane RE. Neurologic deficits following epidural or spinal anesthesia. Anesth Analg. 1981;60:150-61.

Selander D, Dhuner KG, Lundborg G. Peripheral nerve injury due to injection needles used for regional anaesthesia. An experimental study of the acute effects of needle point trauma. Acta Anaesthesiol Scand. 1997;21:182-8.

Nirmala BC, Kumari G. Foot drop after spinal anaesthesia: a rare complication. Indian J Anaesth. 2011;55:78-9.

Ghai A, Hooda S, Kumar P. Bilateral foot drop following lower limb orthopedic surgery under spinal anesthesia. Can J Anesth. 2005;52:550.

Ahmad FU, Pandey P, Sharma BS. Foot drop after spinal anesthesia in a patient with a low-lying cord. Int J Obstet Anesth. 2006;15:233-6.

Warner MA, Martin JT, Schroeder DR. Lower-extremity motor neuropathy associated with surgery performed on patients in a lithotomy position. Anesthesiology. 1994;81:6-12.

Sahai-Srivastava S, Amezcua L. Compressive neuropathies complicating normal childbirth: case report and literature review. Birth. 2007;34:173-5.

Radawski MM, Strakowski JA, Johnson EW. Acute common peroneal neuropathy due to hand positioning in normal labor and delivery. Obstet Gynecol. 2011;118:421-3.

Symons JA, Palmer GM. Neuropathic pain and foot drop related to nerve injury after short duration surgery and caudal analgesia. Clin J Pain. 2008;24:647-9.

Waldron JS, Oh MC, Chou D. Lumbar subdural hematoma from intracranial subarachnoid hemorrhage presenting with bilateral foot drop: case report. Neurosurgery. 2011;68:835-9.

Oh SJ. Electromyographic studies in peripheral nerve injuries. South Med J. 1976;69:177-82.

Campbell WW. Evaluation and management of peripheral nerve injury. Clin Neurophysiol. 2008;119:1951-65.

Foot drop: an iatrogenic complication of spinal anesthesia

Pé caído: uma complicação iatrogênica da anestesia espinhal

Vipin Kumar Goyal; Vijay Mathur

Abstract

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