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Trigeminal nerve block as a complication of epidural anesthesia.

BACKGROUND AND METHODS: A healthy pregnant woman underwent labor under successful epidural analgesia with a total drug mass of 100 mg plain bupivacaine plus 100 micrograms fentanyl in three doses given over 150 minutes. RESULTS: Ninety minutes after the last dose, she developed signs and symptoms of a left trigeminal nerve block along with an ipsilateral Horner's syndrome. The cutaneous anesthesia level reached C6 on the left and T6 on the right side. Neurologic symptoms disappeared four hours later. CONCLUSION: An excessive upward epidural extension of bupivacaine block, reaching the trigeminal spinal nucleus and/or tract in the cervical spinal cord, is postulated.

Adult↗
PubMed1991

[An epidural spinal abscess as a lethal complication of peridural anesthesia].

We present a 71-year-old male in whom an epidural abscess developed within a short temporal interval after an epidural anesthetic. Due to different locations of the abscess and the site of the epidural puncture, the diagnosis was quite problematic. The initial symptoms consisted of pain in the shoulder-neck region, elevated temperature, and leucocytosis 1 week after the puncture was performed. The further course presented a picture of high spinal paralysis with respiratory insufficiency and massive cardiovascular problems. Magnetic resonance imaging of the cervical spine confirmed the suspected diagnosis of an epidural abscess (Fig. 1). Due to the reduced general condition of the patient, an operation was initially not possible. After the patient's condition had stabilized under antibiotic therapy with penicillin G, vancomycin, and gentamycin, exploration of the abscess area was performed. Histologic studies showed granulomatous tissue resulting from the previous inflammation. During the subsequent course of the disease, the clinical symptoms did not regress significantly. The patient required prolonged mechanical ventilation and died of recurrent bronchopulmonary infections after 5 months of intensive care treatment. The probable pathogenesis of the abscess as well as the diagnostic and therapeutic aspects are discussed in summary.

Abscess↗
PubMed1991

Retinal detachment as a complication of retrobulbar anesthesia.

The authors report an unusual case of retinal detachment after cataract surgery in a 48-year-old man in which it appeared that the retrobulbar needle passed through the sclera and tracked beneath the retina before perforating the retina superior to the disc. The cause of the detachment was not clearly defined until a depigmented line was observed after reattachment of the retina.

Anesthesia, Local↗