Transient aphonia, aphagia and facial tingling following intrathecal administration of fentanyl

Abstract

Subarachnoid block with local anaesthetic agent and opiod as an adjuvant is a well-known technique with a good record of safety. However, some rare neurological complications like aphonia, dysphagia and tingling sensation have been reported following their administration in pregnant females posted for labour analgesia or caesarean section. We report a case of transient aphonia, aphagia and facial tingling following intrathecal administration of bupivacaine along with fentanyl for lower limb wound debridement in a male patient.

Transient aphonia following spinal anesthesia during emergency cesarean section: Case report and review of literature

“…Interestingly, the presentation of these mentioned cases had a variety of presentations, and the duration of recovery was also varied. Though the risk factors, age between 10 and 35 years of age and female gender are present in our case, her lack of similar history in the past, good educational background with school level education, and good socioeconomic status make this diagnosis unlikely 3,4,7 …”

“…The most likely mechanism is due to the rostral spread of the drug to the speech area or cranial nerves, and the transient nature of the symptom is due to the rapid clearance of the drug from the CSF 12 . Studies have shown cases where aphonia alone or accompanied by neurological symptoms have occurred after spinal anesthesia in pregnant females and other surgeries 1,7,11,12 . However, no opioid was used in this case, excluding it as a cause of aphonia.…”

“…12 Studies have shown cases where aphonia alone or accompanied by neurological symptoms have occurred after spinal anesthesia in pregnant females and other surgeries. 1,7,11,12 However, no opioid was used in this case, excluding it as a cause of aphonia.…”

“…Aphonia during spinal anesthesia can be triggered by a wide range of conditions like transient ischemic attack (TIA), absent seizure, subdural block, high spinal block, intrathecal lipophilic opioid injection, and conversion disorder along with cerebrovascular complications of pregnancy due to preeclampsia or eclampsia. 4,[7][8][9] American Stroke Association defines TIA as "a transient episode of neurologic dysfunction caused by focal brain, spinal cord or retinal ischemia, without acute infarction." It can occur due to hypotension, hypoxia, or embolism that compromises cerebral or vertebrobasilar circulation.…”

Transient loss of voice during labour analgesia

“…Gupta et al . [ 2 ] reported aphonia and aphagia in a male patient posted for lower limb debridement at 3 min after receiving 12.5 mg heavy bupivacaine with 25 μg fentanyl intrathecally which recovered spontaneously in 10-15 min. In both cases the authors believe extensive cephalad spread of fentanyl through the Cerebrospinal fluid (CSF) as the cause for neurological symptoms.…”