Post spinal limb weakness.

[neelam nalge]

Hello;
      I would like to share this case.40 years old average built ASA Grade 1 female for vaginal hysterectomy.spinal given in sitting position with 26G needle .L4-5 spacemidline.single attempt .4 cc of 0.5% heavy bupivacaine.Level T8.Lithtomy after 10 mins.surgery duration 2 hours.intraop uneventful.vitals stable.I/o satisfactory.
               2 days after surgery pt c/o inability to stand,knee weakness,tingling numbness in rt leg.surgeon started with vit B inj & gave a call.I went to see the pt then she was having difficuty in getting up from sitting position,but once up was able to walk.C/o of tingling numbness on lateral side of right knee & sole of right foot.Other limb NAD.o/e examination reduce touch sensation on rt.sole.pain temp Normal..All other dermatomes NAD.????????????????.culprit....I think lithtomy position.Any advise ,help, similar experience.

[yogenbhatt1]

Hi,
Dr. Neelam, I think you are on the dot for the diagnosis. Anyone would like to involve or blame the anaesthesiologist. But an overzealous position given by OT staff for a vag Hyst, is the cause of this. The nerves get stretched and typical symptom is quadriceps plasy, the leg gives in or buckles up at an attempt to get up from the bed. It is a very frightening feel for the patient. Be patient and things will get ok. Ofcourse you will have to rule out a few other conditions like nerve injury or an epidural hematoma etc. If you do not investibgate, this may amount to negligence.
Management wise, nothing like a shot of Methyle pred 250 at the earliest, it may help.
It takes time to settle down, over a week or so.
Glad, you did not get disheartened by the surgeon calling you up.

[neelam nalge]

Dear sir,   Thankyou for ur reply.I would take a chance here to mention that we always feel good & confident that You are always there when we need it.Thanks.Pt investigated & treated ,is absolutely fine now.