Lower limb weakness and paresthesia after combined spinal epidural anesthesia for abdominal hysterectomy: a report of three cases

Abstract

Neurological deficits are the rare but unacceptable complications of neuraxial blockade. We report three
cases of vaginal hysterectomy performed under combined spinal epidural anesthesia (CSE) using 3 ml
of 0.5% hyperbaric bupivacaine (15 mg) in subarachnoid space followed by epidural analgesia top up
after wearing off of spinal anesthesia. One patient complained of unilateral paresthesia and numbness
on left thigh with no motor involvement in the evening postoperatively, two patients developed bilateral
paresthesia and numbness over anterior thigh and knees and motor weakness in both lower limbs on next
day morning. Epidural catheter was removed immediately and treated with oral tab prednisolone and tab
methylcobalamin. All patients had complete recovery and were discharged after a week. Unrecognised
mechanical irritation of the nerve roots by epidural catheter is thought to be the cause. We conclude that
patients with epidural catheter should be monitored and on appearance of any neurological symptoms
the catheter be removed to prevent permanent neurological sequelae.