Transient Lower Extremity Weakness in an Obstetric Patient Unrelated to Epidural Anesthesia

摘要

The use of epidural anesthesia to provide pain relief during labor and delivery is increasing in popularity. The relative safety of this technique has been established, but postoperative complications can occur. The following is a report of transient neurological dysfunction which occured in an obstetrical patient given epidural anesthesia, but which was not related to the anesthesia.Twenty-four hours after surgery, the patient complained of numbness in both lower extremities and inability to cross her legs, bend her knee, or dorsiflex her left foot. She had neither headache nor ocular or auditory symptoms. Physical examination revealed normal pinprick sensation throughout both lower extremities. Nuchal rigidity was not present, but spasm of paravertebral muscles was noted. There was no tenderness over the skin puncture site. There was some pitting edema over the coccyx.A few hours later, the patient mentioned (for the first time) that her buttocks were bothering her. Examination of the gluteal area revealed a subcutaneous lump (measuring 2 x 3 cm) in each buttock. The medication chart showed that the patient had received 16 intramuscular injections in the buttocks (meperidine, promethazine, hydroxyzine, and Deladumone) within a period of 30 hours. A presumptive diagnosis of traumatic bilateral sciatic neuritis or neural compression by the unabsorbed medication was made. Vigorous physical therapy was instituted, and the patient was encouraged to apply hot water bags over the gluteal area. Her condition gradually improved over the next few days. Neurological examination was normal on the 5th postoperative day.