Spinal myoclonus following combined spinal‐epidural anaesthesia for Caesarean section

Abstract

Summary A nulliparous woman presented with pre‐eclampsia at 39 weeks' gestation. A combined spinal‐epidural anaesthesia was employed for Caesarean section but the spinal component produced no discernible block, so the epidural was topped up with 20 ml ropivacaine 0.75% without problem and surgery was uneventful. A week after delivery she developed twitching of her legs and opisthotonus, that was initially thought to be eclampsia but was subsequently diagnosed as spinal myoclonus. She was treated with oral carbamazepine and diazepam, with improvement over the next 4 days, and discharged home a week later taking oral carbidopa and levodopa. Her symptoms resolved completely 6 months after the initial event.

Complete failure of spinal anaesthesia in obstetrics

“…Such a situation will be familiar to all those who perform these techniques regularly, and they may become such an accepted part of practice as to be unremarkable. 4 Whilst this situation may be accepted ("just another failed spinal," "the local anaesthetic didn't work"), would the same view be taken if it were the case for general anaesthesia ("just another failed GA", "the propofol didn't work")? After reviewing a number of cases over several years in which uneventful spinal anaesthesia completely failed for no apparent reason, a literature search was conducted in an effort to explain the apparently inexplicable.…”

Transient spinal myoclonus due to epidural levobupivacaine infusion,

“…[1,5,4,13] Girişim sırasında iğnenin oluşturabileceği bir yaralanma veya kateterin sürekli irritasyonunun ön boynuz hücrelerinde anormal sinyal iletimine neden olabileceği belirtilmektedir. [13] Bizim olgumuzda uygulama sırasında hiçbir komplikasyon gözlenmediği gibi kateterden lokal anestezik infüzyonunun yapıl-madığı dönemlerde de miyoklonus gözlenmemiştir.…”

“…[5,7,10,14] Bupivakain ve ropivakainin miyoklonusa neden olduğunu bildiren yayınlar mevcuttur. [5,15,16] Olgumuz sürekli levobupivakain infüzyonu nedeniyle miyoklonus gelişen ilk olgudur.…”

“…[1,2,3] Epidural lokal anestezik infüzyonu sonrası spinal miyoklonus son derece nadir bir komplikasyondur ve çok az sayıda bildirilmiştir. [4,5] Bu olgu ile analjezi amacıyla uygulanan epidural levobupivakain infüzyonu sonrası gelişen spinal miyoklonusun sunulmasını amaçlamaktadır. …”

Transient spinal myoclonus after spinal anaesthesia with bupivacaine in the perioperation period

“…

Spinal myoclonus is an unusual, self-limiting adverse event during the practice of spinal anaesthesia [1,2,3,4,5]. Although the exact etiology of medication-induced spinal myoclonus is unclear, it has been postulated that reduced activity of inhibitory mechanisms or increased excitability of facilitatory mechanisms at the level of motor neurons or interneurons is responsible [6].

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