To the Editor:-We would like to draw your attention to a case of transient neurologic symptoms after spinal anesthesia. A 48-yr-old man with no history of back pain scheduled for ureterlithotripsy received spinal anesthesia with 75 mg hyperbaric lidocaine, 5%. The spinal was performed in the sitting position with a 25-gauge Quincke needle. Spinal placement was atraumatic, with free flow of cerebrospinal fluid and no blood, pain, or paresthesia. The operation, at the lithotomy position, lasted 50 min and was uneventful, with no significant hemodynamic changes. The patient received in total 1,200 ml Ringer's lactate solution and 2 mg midazolam.
Recovery was also uneventful, and the patient referred only a slight burning-itching sensation from the urethra, for which no analgesics were administered. However, 6 h postoperatively severe pain from his back developed, radiating to the heels of both legs, along with a burning sensation over both calves and heels. The patient was restless, changing continuously positions, without any relief. The urologist administered 75 mg pethidine intramuscularly and called the anesthetist. At examination, pain referred down both legs had become moderate, but the burning sensation remained unchanged; sensation and strength was normal, the patient was afebrile and there was no local tenderness over the site of injection. Computed tomography performed an hour later, did not reveal any pathology in the lumbosacral area.
At examination, three tender points (two paraspinally and one over the left iliac crest) were noted, and after the negative computed tomography, these were infiltrated with 1 ml bupivacaine, 0.25%, each. Within 5 min, the pain and the burning sensation completely disappeared; neither recurred, and the patient was discharged after 24 h, having received no more analgesics.
Because this seemed to us to be a case of transient neurologic symptoms after spinal anesthesia and not just myofascial pain, we did not expect infiltration of tender points to be of real help. However, from our experience, infiltration of similar trigger points has been useful in alleviating pain in the back (more clearly myofascial in origin), after spinals for surgery in the lithotomy position, in another two patients. We wonder whether a study using laboratory neurologic tests, would prove to be useful in further elucidating these cases, establishing the criteria for transient neurologic symptoms [1]cases and "rediscovering" their incidence. [2]
Konstantinos Papilas, M.D.
Loukia Papaspyrou, M.D.
Panagiota Caberi, M.D.
Staff Anesthesiologist; Sismanoglion Hospital; Athens, Greece; kpapilas@otenet.gr
Andreas Skolarikos, M.D.
Resident in Urology; Urology Clinic; Medical School; University of Athens; Athens, Greece
(Accepted for publication February 8, 1999.)
