Rapid Onset of Guillain-Barré Syndrome After an Obstetric Epidural Block

Abstract

Reports of acute onset of Guillain-Barré syndrome (GBS) after epidural anesthesia/analgesia after labor and cesarean delivery has raised concern of a correlation between GBS and the use of neuraxial anesthesia. We present a patient who developed bilateral lower extremity weakness and paraparesis within hours after removal of an epidural catheter for cesarean delivery. The clinical diagnosis was highly suggestive for GBS after magnetic resonance imaging, cerebrospinal fluid findings, electromyogram, and nerve conduction studies. We discuss the pathophysiological mechanisms suggested in previous case reports and describe the relationship between epidural analgesia and GBS.

Inflammatory demyelinating polyneuropathy after total hip arthroplasty

“…Campylobacter jejuni is the most frequently identified organism with reports also identifying other infectious agents such as Epstein-Barr virus, varicella-zoster virus, and Mycoplasma pneumonia [14] . GBS has been reported after both spinal and epidural anesthesia [15] , [16] . Epidural morphine has even been proposed as a potential cause [17] , [18] .…”

Successful popliteal and femoral nerve blocks in a patient with severe Guillain‐Barré syndrome

“…Guillain-Barré syndrome (GBS) refers to a diverse group of acute onset, immunologically mediated demyelinating disorders of the peripheral nervous system [1,2]. It is often preceded by an otherwise unremarkable infection 10-14 days prior to its onset [1] and is a known complication of HIV infection [3].…”

“…There have been many reports on the use of spinal and epidural anesthetics for labour and caesarean section without adverse sequelae in patients with GBS [4,5]. However, one report described worsening of the symptoms of GBS after neuraxial anesthesia [6] and another reported a case of new onset GBS in a parturient following labour with lumbar analgesia [2]. According to the 'double-crush' theory, nerves that are already compromised are at higher risk of injury if an insult is delivered at a second location [7].…”

Guillain-Barre Syndrome After Robotically Assisted Laparoscopic Prostatectomy: First Case Report

“…They entertained a hypothesis based on local trauma from epidural injection as a probable pathogenic mechanism, although no definitive link has been established. 5 …”