Foot Drop after Combined Spinal Epidural: A Rare Neurological Complication

JOURNAL TITLE: Journal of Research & Innovation in Anesthesia

Author
1. Deepa Kane
2. Shraddha S Mathkar
3. Pradeep Tiwari
4. Shruti Patil
ISSN
DOI
10.5005/jp-journals-10049-0064
Volume
4
Issue
1
Publishing Year
2019
Pages
1
Author Affiliations
1. com.mps.common.model.Contributor@5a494066 ,
2. com.mps.common.model.Contributor@65252f0a ,
3. com.mps.common.model.Contributor@c402146 ,
4. com.mps.common.model.Contributor@5f662ed8
Article keywords
Central neuraxial blockade, Foot drop, Mononeuropathy, Neurological deficit

Abstract

Neurological deficit post central neuraxial blockade is rare but considered for highest compensation. We present a case of S1 mononeuropathy presented as foot drop after combined spinal epidural. A 30-years-old male with lower limb fracture was posted for plating. Patient was ASA grade I and all his investigations were normal. Combined spinal epidural was planned. The procedure was performed following all standard operating procedures. Surgical procedure was uneventful, epidural catheter was removed 12 hours postoperatively. 24 hours postoperatively foot drop was noted. Patient was evaluated by neurologist. Ankle dorsiflexion power-1/5, extensor hallucis longus and extensor digitorum brevis were weak. MRI spine was done, which was normal. Neurologic impairment after subarachnoid block is rare, but multifactorial. The causes can be divided into iatrogenic or idiopathic. In some cases it could be a coincident to clinical presentation of any other organic disease. Trauma by the needle or catheter are the commonest causes for the neurological deficit. Regular follow-up and supportive treatment is important in these patients. Medicolegal issues is a big worry in such cases.

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