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Canadian Journal of Anesthesia

, Volume 52, Issue 5, pp 493–497 | Cite as

Prolonged duration of anesthesia in a patient with multiple sclerosis following paravertebral block

  • Brendan T. Finucane
  • Ockert C. Terblanche
Regional anesthesia and pain

Abstract

Purpose

To explore the possibility that the prolonged duration of anesthesia following paravertebral block was related to the presence of multiple sclerosis in a patient undergoing elective inguinal hernia repair.

Clinical features

A healthy 33-yr-old female presented for elective inguinal hernia repair. The procedure was performed under general anesthesia and a paravertebral block was performed at the end of the procedure for postoperative pain relief, whilst the patient was still anesthetized. Upon recovering from general anesthesia it was noted that the patient had a flaccid paralysis of both lower extremities. She was also very nauseated and required antiemetics and vasopressors for hypotension. A differential diagnosis of subarachnoid, subdural or epidural spread was considered. The presence of an epidural hematoma was also considered. The block regressed very slowly with full return of function in 12.5 hr. The duration of action of the block was far longer than one would expect following spinal, epidural or subdural spread of a local anesthetic. Urinary catheterization was performed electively to prevent urinary retention. The patient was discharged home late that evening. Prior to discharge she volunteered that she was being investigated for multiple sclerosis. One month later the diagnosis of multiple sclerosis was confirmed.

Conclusion

In conclusion the extended duration of central neural blockade following paravertebral block, may have been related to an abnormal uptake of local anesthetics into the spinal cord in the presence of demyelination.

Keywords

Multiple Sclerosis Regional Anesthesia Inguinal Hernia Repair Epidural Hematoma Anesthetize Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Prolongation de l’anesthésie après un bloc paravertébral chez une patiente atteinte de sclérose en plaques

Résumé

Objectif

Vérifier l’hypothèse voulant que la durée prolongée de l’anesthésie suivant un bloc paravertébral soit reliée à la présence de sclérose en plaques chez une patiente qui a subi la cure d’une hernie inguinale réglée.

éléments cliniques

La cure d’une hernie inguinale réglée a été réalisée chez une femme de 33 ans. L’opération, sous anesthésie générale, a été suivie d’un bloc paravertébral pour l’analgésie postopératoire alors que la patiente était toujours anesthésiée. Au réveil de l’anesthésie générale, on a noté une paralysie flasque aux deux membres inférieurs. La patiente était aussi nauséeuse et a reçu des antiémétiques et des vasopresseurs pour l’hypotension. Un diagnostic différentiel d’extension sous-arachnoïdienne, sous-durale ou péridurale du bloc a été envisagé. On a considéré aussi à la présence d’un hématome péridural. Le bloc a régressé très lentement et la récupération fonctionnelle complète a exigé 12,5 h. La durée d’action du bloc a été beaucoup plus longue qu’on pouvait s’y attendre à la suite de la diffusion rachidienne, péridurale ou sous-durale d’un anesthésique local. Un cathétérisme urinaire a été réalisé pour empêcher la rétention urinaire. Avant son départ, tard le soir, la patiente a souligné qu’elle devait subir des examens pour la sclérose en plaques ; le diagnostic a été confirmé un mois plus tard.

Conclusion

La durée prolongée du bloc neural central qui suit un bloc paravertébral peut être reliée à un captage anormal d’anesthésique local dans la moelle épinière en présence de démyélinisation.

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Copyright information

© Canadian Anesthesiologists 2005

Authors and Affiliations

  1. 1.Department of Anesthesiology and Pain MedicineUniversity of AlbertaAlbertaEdmontonCanada

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