Patchy Spinal Anesthesia

Abstract

To the Editor: Patchy anesthesia is a common, albeit unwelcome, complication of epidural anesthesia. We report a patchy block after spinal anesthesia for right total hip arthroplasty in a 67-yr-old 70-kg man. The patient had severe chronic obstructive airway disease and refused general anesthesia. With the patient in the right lateral position (operative side down), an epidural catheter was threaded at the L3-4 interspace but did not produce a nerve block. We then placed a 22-gauge Quincke spinal needle in the intrathecal space at L4-5. After confirming free flow of cerebrospinal fluid, we administered 3 mL 0.5% hyperbaric bupivacaine. After 5 min the patient was turned onto his back. By 15 min the patient had bilateral motor block of both legs but minimal sensory block of the L2-3 dermatomes on the right. With no improvement in the block by 30 min, we proceeded with general anesthesia without incident. Postoperative magnetic resonance imaging of the spinal space demonstrated right paramedian intervertebral disk herniation causing L3 nerve root compression. Patchy spinal block is a rare occurrence. Sun (1) reported a similar event in a patient who had had three previous spinal operations. The spread of local anesthetic could be impeded by a herniated disk, as in our patient, or by septa within the intrathecal space (2,3). Mustafa Suren, MD Gökcen Basaranoglu, MD Basol Bay, MD Department of Anesthesiology [email protected] Unal Egeli, MD Ismail Afacan, MD Department of Radiology Kahraman Ozturk, MD Ozgur Ortak, MD Department of Ortopedie and Traumatologia Vakıf Gureba Hospital Istanbul, Turkey