1/9. An "enigmatic" cause of back pain following regional anaesthesia for caesarean section: septic pelvic thrombophlebitis.A case of septic pelvic thrombophlebitis is reported. This presented as back pain and leg weakness 18 days after regional anaesthesia for caesarean section. The patient was referred to the Department of Anaesthesia. Obstetric review of the patient at the request of the anaesthetist led to a CT scan that demonstrated the diagnosis. This condition may lead to fatal "on-table" pulmonary embolus if the thrombosed vein is handled during an exploratory laparotomy. Treatment should be conservative with antibiotics and anticoagulation. This case illustrates the need for awareness amongst anaesthetists of possible surgical causes for morbidity that may initially appear anaesthetic-related.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/9. Facet joint injection: a rare form cause of epidural abscess formation.The posterior zygo-apophyseal joints (facet joints) may be a significant source of back pain. Invasive treatment typically consists of injecting the joints with local anaesthetic and steroid or by radiofrequency ablation of the nerve supply to the joint. Facet joint injection is generally considered to be a very safe procedure with few significant side effects reported.epidural abscess is a rare but potentially very serious occurrence. Most cases occur spontaneously but the condition may complicate epidural anaesthesia, spinal anaesthesia or epidural steroid injection. We report a case in which facet joint injections resulted in epidural abscess formation. To our knowledge this has not previously been reported.- - - - - - - - - - ranking = 0.4keywords = anaesthesia (Clic here for more details about this article) |
3/9. Midline prolapse of a lumbar intervertebral disc with compression of the cauda equina.Midline prolapse of a disc causing compression of the cauda equina is rare but needs urgent diagnosis and surgical treatment. The onset of bladder and rectal paralysis with saddle anaesthesia should be viewed with a high index of suspicion in a patient with backache and sciatica. Eight cases were seen over a period of five years, and they fell into three clinical groups. Group I patients presented with a sudden onset without any previous symptoms related to the back. Group II patients had a history of recurrent episodes of backache and sciatica, the latest episode resulting in involvement of the cauda equina. The group III patient was indistinguishable from one with a tumour as he presented with backache and sciatica slowly progressing to paralysis of the cauda equina. The prolapse was at the disc between L5 and S1 vertebrae in 50 per cent of the patients, most of whom did not have any limitation of straight leg raising. Urgent myelography and equally urgent removal of the disc within two weeks of the onset of the symptoms resulted in almost complete motor and bladder recovery within five months after the operation in most cases. However, recovery of sensation and sexual function was incomplete even four years after the operation.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
4/9. Successful treatment of a chronic post-traumatic 5-year-old osteoporotic vertebral compression fracture by percutaneous vertebroplasty.Osteoporotic vertebral compression fracture (VCF) is a frequently encountered clinical problem associated with chronic pain and disability. Conservative treatment in the form of bed rest, pain control and bracing may create a vicious circle, in which reduced activity leads to further reduction in bone density and fracture risk. Percutaneous vertebroplasty (PVP) is an accepted treatment modality for osteoporotic vertebral body collapse present for less than 1 year, vertebral myeloma, haemangioma, metastasis and recent traumatic fractures (between 3 and 12 months). We describe an osteoporotic patient in whom successful PVP was performed, under general anaesthesia using CT and fluoroscopic guidance, in a post-traumatic 5-year-old VCF with complete alleviation of debilitating pain. In the light of our experience, we suggest that PVP should be carried out in a series of similar patients to asses its value as a treatment option in patients with chronic osteoporotic vertebral fractures for pain relief and improvement in mobility, independent of fracture age.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
5/9. Backache after extradural anaesthesia in the postpartum period: dissection of thoracic aneurysm.We describe a case of postpartum ruptured dissecting aneurysm of the thoracic aorta, unrelated to the anaesthetic management with extradural anaesthesia. This complication is discussed in detail, as the anaesthetist may be the specialist required to respond to the common presenting symptom of severe back pain.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
6/9. Transient blindness following epidural analgesia.A 43-year-old woman was given an epidural injection of steroid mixed with local anaesthetic, under general anaesthesia, for treatment of low back pain. In the recovery room she complained of blindness in one eye. Fundoscopy revealed retinal and vitreous haemorrhages in both eyes. Retinal haemorrhages can be caused by an increase in intracranial pressure and are therefore a possible complication of epidural anaesthesia.- - - - - - - - - - ranking = 0.4keywords = anaesthesia (Clic here for more details about this article) |
7/9. Temporary back and leg pain after bupivacaine and morphine spinal anaesthesia.Transient neurological symptoms have been reported after hyperbaric lidocaine 5% spinal anaesthetics. We report a patient with neurogenic back and leg pain after uncomplicated bupivacaine and morphine spinal anaesthesia. A healthy 39-yr-old woman received 1.6 ml hyperbaric bupivacaine 0.75% and 250 micrograms morphine intrathecally. Two hours later, the patient experienced discomfort during suturing of the peritoneum and surgery was completed under general anaesthesia. Recovery was uncomplicated until 13 hr after intrathecal injection, when the patient complained of burning pain in her back extending to the front of the abdomen and similar pain in her thighs. Neurological consultation was obtained. Treatment was started with amitriptyline and the symptoms resolved slowly. Complete recovery occurred over three months. Further studies to assess symptoms after spinal anaesthesia are indicated.- - - - - - - - - - ranking = 1.4keywords = anaesthesia (Clic here for more details about this article) |
8/9. Bilateral leg pain following lidocaine spinal anaesthesia.Spinal anaesthesia is considered to be a safe and effective method of providing anaesthesia for a variety of surgical procedures. Recently, observations have been made that associate the use of hyperbaric lidocaine with bilateral leg pain. We report nine patients who developed strikingly similar neurological symptoms following routine spinal anaesthesia using hyperbaric lidocaine 5% solutions. All patients had their anaesthesia and surgery in the ambulatory or "short stay" care setting. In each patient, moderate to severe, bilateral, posterior, leg pain developed within 24 hr of the anaesthetic administration. The pain was described as either sharp or cramping with or without associated back pain. None of the patients demonstrated objective neurological deficits. In all cases the symptoms resolved fully within one week. The dose of lidocaine administered in these nine patients ranged from 40 to 100 mg. Although the aetiology of the symptoms is not clear the local anaesthetic or its formulation may have been responsible.- - - - - - - - - - ranking = 1.6keywords = anaesthesia (Clic here for more details about this article) |
9/9. Spinal subdural haematoma in a parturient after attempted epidural anaesthesia.We report a case of spinal subdural haematoma with neurological deficit in a 36-yr-old woman following Caesarean section for severe preeclampsia and placental abruption. She had been taking chronic trifluoperazine treatment for depression. Her activated partial thromboplastin time (aPTT) was 49 sec (normal = 26-36) but all other tests of coagulation were normal. Epidural anaesthesia was attempted but, despite a negative test dose, injection of local anaesthetic resulted in a generalized seizure and general anaesthesia was induced. Seventy-two hours after delivery, she was found to have bilateral leg weakness, urinary incontinence, absent rectal sphincter tone and asymmetrical leg reflexes. The diagnosis of spinal haematoma was confirmed by magnetic resonance imaging. She underwent emergency laminectomy and made a full neurological recovery.- - - - - - - - - - ranking = 1.2keywords = anaesthesia (Clic here for more details about this article) |