Frequent Spinal Anesthesia in a Patient with Traumatic Lower Extremity Injury: A Case Report

Abstract

Introduction Spinal anesthesia is a commonly used anesthetic technique for lower extremity surgery. Despite its widespread use, the acceptable frequency of repeated spinal anesthesia for a patient is unclear. Therefore, herein, we report a patient who frequently received spinal anesthesia. Case Presentation A 21-year-old man with severe head and leg injury was admitted to the hospital after a motorcycle accident. On admission, he had a tracheal tube and GCS score of six. After emergency vascular and orthopedic surgeries under general anesthesia, he was transported to the ICU. Within 12 days of admission to the ICU, he was extubated with full awareness. After consultation with a neurosurgeon for spinal anesthesia, the patient received seven spinal anesthesia procedures for his lower extremity injury in a period of 15 days. Spinal anesthesia was performed at the L3 - L4 or L4 - L5 interspace with 24 or 25-gauge Quincke needles in the sitting position (12 - 15 mg of 0.5% hyperbaric bupivacaine) by four anesthesiologists. Despite performing several spinal anesthesia procedures, no neurologic sequelae were observed. Finally, he was discharged in a good overall condition. At a four-month follow-up, the patient was in a stable situation without any neurological complications. Conclusions This report emphasizes that spinal anesthesia with hypertonic bupivacaine could be used several times for a patient in some situation.

Post-spinal Anesthesia Low Back Pain in Obese Female Patients: Comparison of the Median Versus Paramedian Approach

“…The severity of back pain decreases with the passage of time, with only two patients complaining of pain after three months. According to a recent study, the frequency of PDPB dropped from 29% one day after spinal anesthesia to 5% four weeks later, and the severity of the pain also lessened over time [ 12 ]. The results of the current study agreed with those of earlier ones [ 9 - 11 ].…”

Drop Foot After Spinal Anesthesia

“…In the event of paresthesia, the needle should be immediately removed to avoid radiculopathy after surgery. 9 The local anesthetic itself can cause neurotoxicity effect. Early reports reveal that moderate to severe pain in the lower back, buttocks, and posterior thigh that appears within 24 hours after complete recovery from spinal anesthesia can be a manifestation of transient radicular irritation of the lumbosacral nerves.…”

“…5 It is also recommended that repeated injections of local anesthetics should be avoided to prevent toxic effects on the spinal cord. 9 The exact mechanism of local anesthetic toxicity are not fully understood. There are several aspects that involved in the local anesthetic toxicity, including inhibition of voltage dependent calcium channels, apoptosis, mitochondrial dysfunction, endoplasmic reticulum calcium depletion and DNA damage.…”

Neurofascial Dextrose Prolotherapy for Managing Chronic Ankle Ligament Injury

“…Chronic ankle instability is a sequela of repeated sprains; however, it can happen after a single sprain, even after six years (3). Various methods have been introduced to treat ligamentous injuries (4,5), such as corticosteroid injection (6), platelet-rich plasma, prolotherapy (7), and even botulinum toxin injection (8) but the most effective treatment of ankle tendinopathy requires further investigations. Proliferation therapy, also named prolotherapy, is known as an effective treatment of different musculoskeletal disorders such as rotator cuff tendinopathy, plantar fasciitis, and knee osteoarthritis (9)(10)(11).…”