Vocal Cord Palsy as a Complication of Epidural Anaesthesia

Abstract

Cranial nerve palsy is a rare but recognised complication of epidural anaesthesia, most commonly presenting as diplopia secondary to abducens nerve palsy. While upper cranial nerve palsies have been documented on numerous occasions, lower cranial nerve palsies, including recurrent laryngeal nerve palsy, are exceedingly rare. This case describes a 37-year-old female who, following epidural anaesthesia for spontaneous vaginal delivery of her first child, presented with dysphonia. Flexible laryngoscopy confirmed a left vocal cord palsy, and computed tomography ruled out any mass lesions along the course of the recurrent laryngeal nerve. Here, we discuss a case of vocal cord palsy secondary to epidural anaesthesia, an extremely rare complication. We also discuss the proposed etiology, treatment, and outcomes in patients with this condition. Cranial nerve palsy should be an important differential in patients presenting with dysphonia following spinal or epidural anaesthesia.

Vocal Fold Paralysis After Spinal and Epidural Anesthesia: A Case Report and Scoping Review

“…11 The same mechanism can be hypothesized for upper cranial neuropathies resulting as complications of epidural and spinal anesthesia, with ICH presumably resulting in nerve damage due to stretching, compression, or ischemia that seems to involve mainly the abducens nerve, one with a long intracranial course particularly vulnerable to traction injury. 7,12,13 As stated, all three patients who underwent electromyography showed an involvement of both the superior and the RLN and two patients reported motility deficits of the soft palate, thus suggesting a vagal nerve injury rather than an isolated involvement of the RLN. The delayed onset observed in some of the reported cases, including ours, would suggest the hypothesis of a slow leak of CSF, with symptoms emerging days to weeks after the procedure.…”

“…Mc Loughlin et al pointed out that the pathophysiology might be similar to that of postdural puncture headaches, probably resulting from brain descent due to ICH secondary to loss of cerebrospinal fluid (CSF) volume 11 . The same mechanism can be hypothesized for upper cranial neuropathies resulting as complications of epidural and spinal anesthesia, with ICH presumably resulting in nerve damage due to stretching, compression, or ischemia that seems to involve mainly the abducens nerve, one with a long intracranial course particularly vulnerable to traction injury 7,12,13 . As stated, all three patients who underwent electromyography showed an involvement of both the superior and the RLN and two patients reported motility deficits of the soft palate, thus suggesting a vagal nerve injury rather than an isolated involvement of the RLN.…”