Perinatology.  2023 Jun;34(2):88-93. 10.14734/PN.2023.34.2.88.

Cauda Equina Syndrome Secondary to Chemical Injury due to Combined Spinal– Epidural Anesthesia for Cesarean Delivery: A Case Report

• Lee AH
• Won HS
• Kim SY
• Song S
• Ye DH
• Shin MS

• KMID: 2544100
• DOI: http://doi.org/10.14734/PN.2023.34.2.88

Abstract

During cesarean section, regional anesthesia is commonly performed using local anesthetics, such as lidocaine, bupivacaine, and fentanyl. Some patients complain of symptoms, such as numbness or transient leg weakness, postoperatively, although most symptoms improve after epidural catheter removal. A 36-year-old multigravida woman underwent a cesarean section at gestational age of 38 weeks and 2 days because of a previous cesarean section. She received combined spinal–epidural anesthesia at the lumbar 4 to 5 level, and the procedure was successful at the time. However, she experienced right lower extremity weakness, saddle anesthesia, and difficulty in urination and defeca tion 1 day postoperatively, and such symptoms did not improve despite catheter removal. Magnetic resonance imaging revealed signs of meningitis, and electromyography and nerve conduction test indicated polyradiculopathy. The patient was diagnosed with spinal cord meningitis caused by chemical injury due to bupivacaine, which resulted in cauda equina syndrome. Consequently, she received rehabilitation. After 14 months, her right leg motor grade has improved to grade 4 to 5, although her difficulty in urination and defecation remained. Physicians need to be knowledgeable of neurological complications that may arise from spinal–epidural anesthesia induction. Prompt identification and treatment of such complications are crucial to prevent adverse clinical outcomes and legal concerns.

Keyword

Cauda equina syndrome; Regional anesthesia; Cesarean section; Combined spinalepidural anesthesia