Persistent cauda equina syndrome after cesarean section under combined spinal-epidural anesthesia: a case report

Chen, Xiubin; Xu, Zhendong; Lin, Rong; Liu, Zhiqiang

doi:10.1016/j.jclinane.2015.05.007

Cited by 18 publications

(10 citation statements)

References 27 publications

(25 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is less toxic to the cardiovascular and central nervous systems than bupivacaine . Hyperbaric LA may also increase the incidence of nerve tissue damage, so our center mainly uses 0.5% hypobaric ropivacaine in CSEA. Hypobaric or plain (some are slightly hypobaric) LA are also used in spinal anesthesia for cesarean delivery in some centers .…”

Section: Introductionmentioning

confidence: 99%

Combined spinal‐epidural anesthesia with hypobaric ropivacaine in sitting position significantly increases the incidence of hypotension in parturients undergoing cesarean section

Shen

Zhang

et al. 2016

J of Obstet and Gynaecol

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Combined spinal‐epidural anesthesia with hypobaric ropivacaine in sitting position significantly increases the incidence of hypotension in parturients undergoing cesarean section

Shen

Zhang

et al. 2016

J of Obstet and Gynaecol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although a lower concentration of bupivacaine (0.5%-0.75%) is generally accepted as safe, previous studies have shown that bupivacaine might be neurotoxic at clinically relevant concentrations [ 2 , 3 ]. Cauda equina syndrome, a severe neurological complication, has been associated with spinal anesthesia achieved with 0.5%-0.75% bupivacaine [ 40 ]. Because local anesthetic solutions rarely induce neurologic injury, larger dosages are required to observe their neurotoxic effects.…”

Section: Discussionmentioning

confidence: 99%

The DNA Repair Enzyme XPD Is Partially Regulated by PI3K/AKT Signaling in the Context of Bupivacaine‐Mediated Neuronal DNA Damage

Zhao

Zeng

Luo

et al. 2021

Oxidative Medicine and Cellular Longevity

View full text Add to dashboard Cite

Bupivacaine, a local anesthetic widely used for regional anesthesia and pain management, has been reported to induce neuronal injury, especially DNA damage. Neurons employ different pathways to repair DNA damage. However, the mechanism underlying bupivacaine-mediated DNA damage repair is unclear. A rat neuronal injury model was established by intrathecal injection of (3%) bupivacaine. An in vitro neuronal injury model was generated by exposing SH-SY5Y cells to bupivacaine (1.5 mmol/L). Then, a cDNA plate array was used to identify the DNA repair genes after bupivacaine exposure. The results showed that xeroderma pigmentosum complementary group D (XPD) of the nuclear excision repair (NER) pathway was closely associated with the repair of DNA damage induced by bupivacaine. Subsequently, Western blot assay and immunohistochemistry indicated that the expression of the repair enzyme XPD was upregulated after DNA damage. Downregulation of XPD expression by a lentivirus aggravated the DNA damage induced by bupivacaine. In addition, phosphatidyl-3-kinase (PI3K)/AKT signaling in neurons was inhibited after exposure to bupivacaine. After PI3K/AKT signaling was inhibited, bupivacaine-mediated DNA damage was further aggravated, and the expression of XPD was further upregulated. However, knockdown of XPD aggravated bupivacaine-mediated neuronal injury but did not affect PI3K/AKT signaling. In conclusion, the repair enzyme XPD, which was partially regulated by PI3K/AKT signaling, responded to bupivacaine-mediated neuronal DNA damage. These results can be used as a reference for the treatment of bupivacaine-induced neurotoxicity.

show abstract

“…The causes, in a healthy patient who undergoes a caesarean section, can be varied and all related to neuraxial anaesthesia. The most frequent are: an epidural haematoma [3][4][5][6], a trauma to the intervertebral disc, with leakage of its contents by insertion of the needle [7][8][9], infections by incorrect sterilization of the surgical field or of the instrumentation used [10] and a chemical arachnoiditis from local anaesthetics [11][12][13][14]. In the case analysed in this article, the cause is most likely the last of those mentioned: a hyperbaric bupivacaine arachnoiditis administered at a concentration of 0.5%.…”

Section: Introductionmentioning

confidence: 99%

Case report: incomplete Cauda Equina Syndrome following a caesarean section with spinal anaesthesia

D’Alfonso¹,

Serva²,

Mascaretti³

et al. 2022

Ital J Gynaecol Obstet

View full text Add to dashboard Cite

Background. The Cauda Equina Syndrome is a condition of severe compression or inflammation of the nerves that make up the cauda, that is the anatomical structure consisting of the last spinal roots. Case presentation. On the second day after a caesarean section, a 34-year-old woman at her third pregnancy referred urinary retention, dysesthesia in the buttock and posterior region of the left thigh; constipation on the fifth day. After several clinical examinations, and having excluded the more statistically likely aetiologies, an incomplete Cauda Equina Syndrome was diagnosed, caused by chemical arachnoiditis from a spinal anaesthesia based on hyperbaric bupivacaine. The pathology resolved spontaneously and was not necessary to adopt any therapy other than the minimally invasive one. The urological symptoms were the first to completely disappear, while constipation resolved a few weeks later. Today, only a slight dysesthesia remains in the aforementioned areas. Conclusions. Spinal anaesthesia still proves to be a safe and absolutely practicable method, even if not totally free of serious risks.

show abstract

Persistent cauda equina syndrome after cesarean section under combined spinal-epidural anesthesia: a case report

Cited by 18 publications

References 27 publications

Combined spinal‐epidural anesthesia with hypobaric ropivacaine in sitting position significantly increases the incidence of hypotension in parturients undergoing cesarean section

Combined spinal‐epidural anesthesia with hypobaric ropivacaine in sitting position significantly increases the incidence of hypotension in parturients undergoing cesarean section

The DNA Repair Enzyme XPD Is Partially Regulated by PI3K/AKT Signaling in the Context of Bupivacaine‐Mediated Neuronal DNA Damage

Case report: incomplete Cauda Equina Syndrome following a caesarean section with spinal anaesthesia

Contact Info

Product

Resources

About