Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942006000600008
Brazilian Journal of Anesthesiology
Clinical Information

Plexopatia lombar após histerectomia abdominal: relato de caso

Lumbar plexopathy after abdominal hysterectomy: case report

Elizabeth Vaz da Silva; Marco Antonio Cardoso de Resende; Alberto Pantoja; Adriana Barrozo Ribeiro Furuguem Carvalho; Alexandre Barbosa da Silva; Fabrício Azevedo Cardoso

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Resumo

JUSTIFICATIVA E OBJETIVOS: As lesões neurológicas diagnosticadas no período pós-operatório muitas vezes são atribuídas ao ato anestésico, embora possam também decorrer do ato cirúrgico. O objetivo deste relato foi apresentar o caso de uma paciente submetida à intervenção cirúrgica pélvica que evoluiu com quadro de plexopatia lombar e discutir as possíveis causas. RELATO DO CASO: Paciente do sexo feminino, 38 anos, 58 kg, 1,63 m de altura, estado físico ASA I, internada para tratamento de leiomiomatose uterina, com indicação de histerectomia total abdominal. A monitorização inicial incluiu oxímetro de pulso, pressão arterial não-invasiva, eletrocardioscópio e diurese. Após punção venosa no membro superior esquerdo com cateter 18G, foram administrados, por via venosa, cefazolina (2 g), dipirona (2 g), dexametasona (10 mg) e metoclopramida (10 mg). A anestesia peridural foi realizada com agulha Tuohy 16G, no espaço L3-L4, na linha mediana com a paciente em decúbito lateral esquerdo. Foram administrados 15 mL de ropivacaína a 0,75% e 2 mg de morfina, a seguir posicionado cateter para analgesia pós-operatória. A intervenção cirúrgica não teve intercorrência, mantendo-se a paciente estável sob o ponto de vista cardiovascular. Na visita pós-anestésica, oito horas após o procedimento, a paciente não deambulava e apresentava monoparesia no membro inferior esquerdo. Após investigações clínicas e radiológicas foi descartada a hipótese diagnóstica de síndrome radicular. Como não houve regressão do quadro, 30 dias após foi realizada eletroneuromiografia que foi compatível com plexopatia lombar de possível origem traumática. CONCLUSÕES: O anestesiologista deve estar atento às complicações neurológicas que podem surgir no pós-operatório, participando da elucidação das causas, do tratamento e da sua evolução.

Palavras-chave

COMPLICAÇÕES, Neurológica, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Very often, neurological injuries diagnosed postoperatively are attributed to the anesthesia, but they can also be secondary to the surgery itself. The aim of this report was to present the case of a patient who underwent a pelvic surgery and developed lumbar plexopathy, and to discuss the possible causes. CASE REPORT: A woman patient, 38 years old, 58 kg, 1.63 m, physical status ASA I, was admitted to undergo a total abdominal hysterectomy for treatment of uterine leiomyomatosis. Initial monitoring included pulse oxymetry, non-invasive blood pressure, electrocardioscope, and urine output. After venous cannulation in the left upper limb with an 18G catheter, cefazoline (2 g), dypirone (2 g), dexamethasone (10 mg), and metochlopramide (10 mg) were administered. With the patient in left lateral decubitus, a 16G Tuohy needle was inserted in the L3-L4 space, in the median line, for the epidural block. Fifteen milliliters of 0.75% ropivacaine and 2 mg of morphine were administered, followed by placement of the catheter for postoperative analgesia. The surgery was uneventful, and the patient's cardiovascular parameters were stable. Eight hours after the procedure, at the postanesthetic follow-up, the patient could not walk and presented monoparesis in the left lower limb. The hypothesis of radicular syndrome was ruled out after clinical and radiological evaluation. Since symptoms did not resolve, an electroneuromyography was done 30 days later, and was compatible with lumbar plexopathy, which was possibly caused by trauma. CONCLUSIONS: The anesthesiologist must be aware of the postoperative neurological complications and should be part of the efforts to diagnose their causes, of the treatment, and its evolution.

Keywords

ANESTHETIC TECHNIQUES, Regional, COMPLICATIONS, Neurologic

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