Paresthesias and Motor Dysfunction After Labor and Delivery

Ong, B. Y.; Esmail, A.; Cumming, M.; Kozody, R.; Palahniuk, Richard J.

doi:10.1097/00132582-198710000-00007

Cited by 7 publications

(14 citation statements)

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“…Mothers who experience longer labour or require instrumental delivery are more likely to require regional anaesthesia. This could be a possible reason for the increased incidence of peripheral nerve injuries in mothers receiving regional anaesthesia [2, 5]. Furthermore, when regional anaesthesia is used, more awkward or strained positioning might be tolerated for greater periods, resulting in a greater risk of peripheral nerve compression or stretch.…”

Section: Discussionsupporting

confidence: 74%

“…Nerve injury in the obstetric patient is more common in nulliparous women and is associated with long labour, fetal macrosomia and certain positions that women assume during labour [1–5]. Earlier reports have described injury to a variety of peripheral nerves, including the lateral cutaneous nerve of the thigh [1], sciatic, common peroneal [6], femoral [3] and obturator nerves [7].…”

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confidence: 99%

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Complex regional pain syndrome following protracted labour*

2012

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SummaryObstetric nerve palsies are common and long-term sequelae are fortunately rare. The development of a complex regional pain syndrome is an unusual and less reported complication of labour-related neuropathy. A 28-year-old primigravida who experienced prolonged labour and instrumental delivery under spinal anaesthesia complained of persisting weakness and numbness postpartum, affecting the left lower limb. Urgent magnetic resonance imaging demonstrated no abnormality and a common peroneal nerve injury was later confirmed by nerve conduction studies. Unfortunately, the neuropathy did not resolve as expected and oedema, burning paraesthesia and allodynia affecting the left foot developed within two weeks. She was treated with gabapentin, ibuprofen, topical capsaicin and regular physiotherapy. After six months, the foot drop had resolved and the chronic pain element was significantly diminished. Accepted: 8 July 2012Nerve injury in the obstetric patient is more common in nulliparous women and is associated with long labour, fetal macrosomia and certain positions that women assume during labour [1][2][3][4][5]. Earlier reports have described injury to a variety of peripheral nerves, including the lateral cutaneous nerve of the thigh [1], sciatic, common peroneal [6], femoral [3] and obturator nerves [7]. Nerve injury associated with central neuraxial blockade is also well described, but is less common than intrinsic obstetric palsies [8,9].Peripheral nerve injuries typically manifest as weakness or numbness in the distribution of the affected nerve(s) and most authors describe an uncomplicated resolution of the neuropathy within approximately six months. The development of a complex regional pain syndrome can add significant disability and does not appear to have been previously described in this context. Case reportA primiparous 28-year-old presented to the delivery suite following spontaneous rupture of membranes in the early hours of the morning, 12 days past her expected delivery date. Her pregnancy had been unremarkable and there was no significant medical history. She did not smoke or drink alcohol. Her initial antenatal BMI was 28 kg.m )2 . After 12 hours of labour, a lumbar epidural was sited before a Syntocinon infusion was administered to augment contractions. The epidural was successfully placed in the sitting position at the L3-L4 interspace on the second attempt, but was otherwise straightforward and there was no evidence of any early complications. Effective labour analgesia was achieved using our standard low-dose solution of levobupivacaine 0.1% with fentanyl 2 lgml )1 by continuous infusion.In the following hours, with increasing Syntocinon requirement, analgesia became less than adequate.

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Section: Discussionsupporting

confidence: 74%

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confidence: 99%

Complex regional pain syndrome following protracted labour*

2012

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“…Permanent nerve damage is rare despite the frequent occurrence of paresthesia under epidural catheter insertion [13]. Terasako [14] reported that as the patients under general anesthesia cannot respond to paresthesia during regional anesthesia, such method can increase the risks of postoperative neurological complications.…”

Section: Discussionmentioning

confidence: 99%

Direction of catheter insertion and the incidence of paresthesia during continuous epidural anesthesia in the elderly patients

Kim

Lee

Kim

2013

Korean J Anesthesiol

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BackgroundContinuous epidural anesthesia is useful for endoscopic urologic surgery, as mostly performed in the elderly patients. In such a case, it is necessary to obtain successful sacral anesthesia, and the insertion of epidural catheter in the caudad direction may be needed. However, continuous epidural catherization has been related to paresthesias. This study aimed to evaluate the effects of the direction of the catheter insertion on the incidence of paresthesias in the elderly patients.MethodsTwo hundred elderly patients scheduled for endoscopic urologic surgery were enrolled. The epidural catheter was inserted at L2-3, L3-4, and L4-5 using the Tuohy needle. In Group I (n = 100), the Tuohy needle with the bevel directed the cephalad during the catheter insertion. In Group II (n = 100), it directed the caudad. During the catheter insertion, an anesthesiologist evaluated the presence of paresthesias and the ease or difficulty during the catheter insertion.ResultsIn Group I (n = 97), 15.5% of the patients had paresthesias versus 18.4% in Group II (n = 98), and there was no significant difference between the two groups. In paresthesia depending on the insertion site and the ease or difficulty during the catheter insertion, there were no significant differences between the two groups.ConclusionsOur results concluded that the direction of epidural catheter insertion did not significantly influence the incidence of paresthesias in the elderly patients.

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“…19,23,24,[55][56][57] The reported incidence is inversely related to sample size and varies widely with study methodology. Two retrospective reviews by Ong et al 55 and Vargo et al 56 performed in the 1970s and 1980s found an incidence of 0.8 to 18.9/10,000 deliveries. Similarly, 2 prospective physician-reported audits from the early 1990s of 467,491 24 and 48,066 23 deliveries identified nerve injury rates of 1/10,000 and 4/10,000, respectively.…”

Section: Intrinsic Obstetric Palsiesmentioning

confidence: 99%

Neurologic deficits and labor analgesia

Wong

2004

Regional Anesthesia and Pain Medicine

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Paresthesias and Motor Dysfunction After Labor and Delivery

Cited by 7 publications

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Complex regional pain syndrome following protracted labour*

Complex regional pain syndrome following protracted labour*

Direction of catheter insertion and the incidence of paresthesia during continuous epidural anesthesia in the elderly patients

Neurologic deficits and labor analgesia

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