Lower limb weakness and paresthesia after combined spinal epidural anesthesia for abdominal hysterectomy: a report of three cases

Neurological deficits are the rare but unacceptable complications of neuraxial blockade. We report three cases of vaginal hysterectomy performed under combined spinal epidural anesthesia [CSE] using 3 mlof 0.5% hyperbaric bupivacaine [15 mg] in subarachnoid space followed by epidural analgesia top up after wearing off of spinal anesthesia. One patient complained of unilateral paresthesia and numbness on left thigh with no motor involvement in the evening postoperatively, two patients developed bilateral paresthesia and numbness over anterior thigh and knees and motor weakness in both lower limbs on next day morning. Epidural catheter was removed immediately and treated with oral tab prednisolone and tab methylcobalamin. All patients had complete recovery and were discharged after a week. Unrecognised mechanical irritation of the nerve roots by epidural catheter is thought to be the cause. We conclude that patients with epidural catheter should be monitored and on appearance of any neurological symptoms the catheter be removed to prevent permanent neurological sequelae

Cardiac arrest after simultaneous release of bilateral tourniquets in lower limb orthopaedic surgery: a case report

Surgical tourniquets are commonly used in orthopaedic and trauma surgery, but these have their complications. Reperfusion injury following simultaneous release of bilateral tourniquets is the most likely explanation of cardiac arrest in this case. We describe an unusual complication experienced by a 40 year old, 65 kg healthy male who underwent surgery for trauma to the lower extremity [bilateral fracture tibia]. Bilateral mid-thigh tourniquets [Esmarch bandage] were applied, which were simultaneously released after 90 min. After 5 min of tourniquet release sudden severe hypotension occurred followed by cardiac arrest. Patient was immediately intubated and cardio pulmonary cerebral resuscitation [CPCR] was started. We conclude that bilateral tourniquet application can be hazardous within the safe limit of tourniquet time [<2 hours] and their simultaneous release should be avoided. Moreover, Esmarch tourniquet may generate very high uncontrolled pressures and should be avoided