Anesth Analg 2006;102:1290
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000199208.19825.84
LETTER TO THE EDITOR
Patchy Spinal Anesthesia
Mustafa Suren, MD,
Gökcen Basaranoglu, MD,
Basol Bay, MD,
Unal Egeli, MD,
Ismail Afacan, MD,
Kahraman Ozturk, MD, and
Ozgur Ortak, MD
Department of Anesthesiology, gbasaranoglu{at}hotmail.com (Suren, Basaranoglu, Bay)
Department of Radiology (Egeli, Afacan)
Department of Ortopedie and Traumatologia, Vak f Gureba Hospital, Istanbul, Turkey (Ozturk, Ortak)
To the Editor:
Patchy anesthesia is a common, albeit unwelcome, complication of epidural anesthesia. We report a patchy block after spinal anesthesia for right total hip arthroplasty in a 67-yr-old 70-kg man. The patient had severe chronic obstructive airway disease and refused general anesthesia. With the patient in the right lateral position (operative side down), an epidural catheter was threaded at the L3-4 interspace but did not produce a nerve block. We then placed a 22-gauge Quincke spinal needle in the intrathecal space at L4-5. After confirming free flow of cerebrospinal fluid, we administered 3 mL 0.5% hyperbaric bupivacaine. After 5 min the patient was turned onto his back. By 15 min the patient had bilateral motor block of both legs but minimal sensory block of the L2-3 dermatomes on the right. With no improvement in the block by 30 min, we proceeded with general anesthesia without incident. Postoperative magnetic resonance imaging of the spinal space demonstrated right paramedian intervertebral disk herniation causing L3 nerve root compression.
Patchy spinal block is a rare occurrence. Sun (1) reported a similar event in a patient who had had three previous spinal operations. The spread of local anesthetic could be impeded by a herniated disk, as in our patient, or by septa within the intrathecal space (2,3).
References
- Sun KO. Spinal anaesthesia following previous spinal surgery. Eur J Anaesthesiol 1994;11:321–3.[Medline]
- Armstrong PJ. Unilateral subarachnoid anaesthesia. Anaesthesia 1989;44:918–9.[Medline]
- Nauta HJ, Dolan E, Yasargil MG. Microsurgical anatomy of spinal subarachnoid space. Surg Neurol 1983;19:431–7.[Medline]
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