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Background and Aims Transient Neurological Symptoms (TNS) are characterized by transient moderate to severe pain at the lower extremities, appearing 2-24h post block reversal. Risk factors include the use of lidocaine/mepivacaine, positioning in lithotomy and knee surgery. Aetiology is unclear, but thought to be related to the neurotoxic effects of local anaesthetics, needle trauma or ischemia. The treatment is symptomatic and prognosis is favourable.
Methods A 75-year-old male, ASA III, insulin dependent diabetes was scheduled for an elective inguinal hernia repair. He had a recent lumbar discectomy with good recovery. The airway evaluation revealed short and wide neck and a 3 cm mouth opening, thus spinal anaesthesia was preferred. Spinal block was performed under sedation (3 attempts), at L3-L4 level, with 10mg isobaric bupivacaine 0.5% and 2 mcg sufentanyl.
Results After blockade reversal, a marked clinical picture characterized by lower limbs (LL) paraesthesia, predominantly in the feet. Pain radiated to the left LL and did not follow radicular territory, associated with LL strength deficit bilaterally (Grade 3 and hypoesthesia throughout the left LL, up to T10). MRI excluded acute conditions and neurosurgery/neurology evaluation pointed to aa anaesthesia-related condition. He initiated therapy with dexamethasone and reinitiated ambulatory pregabalin with progressive symptomatic improvement with complete resolution after 10 days.
Conclusions When symptoms surge after central neuraxial block, serious causes such as spinal hematoma, abscess and cauda equina syndrome must be excluded before considering TNS. Despite the risks, regional techniques are safe and useful alternatives to general anaesthesia as in this predicted difficult airway case report.
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