Temporary neurologic complication of spinal ropivacaine in an obstetric patient

Abstract

We aimed to inform transient neurological symptoms after spinal anesthesia and to review postpartum neurological deficits of regional anesthesia. A previously healthy 25-year-old primigravid woman underwent an elective cesarean section. Hypotension and bradycardia were not observed during the operation. On the 25th day postpartum, the patient suffered from numbness and weakness at the lower extremity. On neurological assessment, the muscle strengths in the gastrocnemius and quadriceps bilaterally were 2/5 (+) and 3/5 (+), respectively. The muscle strength at foot dorsiflexion and plantar flexion were 2/5 (+) bilaterally. The patient was unable to walk on toes and walked on heels, and the lower extremities were hypoesthetic. The patellar and the Achilles tendon reflexes were bilaterally negative. No pathological findings could be detected on lumbosacral magnetic resonance imaging (MRI). Electromyography revealed a mixed type of polyneuropathy. The symptoms relieved partially at the end of the 2nd month and regressed completely at the end of the 3rd month. To prevention of irreversible postpartum permanent neurologic deficits, the diagnosis should be made using a detailed neurologic examination along with MRI or computed tomography.