UNILATERAL TRIGEMINAL AND FACIAL-NERVE PALSIES ASSOCIATED WITH EPIDURAL ANALGESIA IN LABOR

Purpose: To report a rare complication related to epidural analgesia f or obstetrics: the association of unilateral trigeminal and facial ner ve palsies in a patient with the clinical syndrome of intracranial hyp otension. Clinical features: A 38-yr-old woman was admitted in pre-ter m labour (at 35 wk gestation). She was receiving 40 mg methadone po da ily for opioid addiction Epidural analgesia for labour was established with 9 ml bupivacaine 0.25%. The patient underwent normal vaginal del ivery of a 2500 g female infant. She developed post-dural puncture hea dache (PDPH) on the third postpartum day which was managed by palliati ve measures: bed rest (patient's position of choice), increased hydrat ion (water: 3 litres eo per day), lysine acetyl salicylate (5.4 g po p er day) and caffeine (600 mg po per day), She developed paraesthesiae and numbness of the right side of the face one day after the onset of PDPH and unilateral facial nerve palsy two days later. There was no ev idence of dural puncture and no cause was found. Treatment of the nerv e palsies with epidural blood patch or epidural dextran 40 was not con sidered to be indicated. Headache disappeared on the 10th postpartum d ay and trigeminal palsy regressed. At the time of discharge, on the 17 (th) postpartum day. neurological examination showed minimal racial as simetry, The patient refused further exploration and follow-up. Conclu sion: Post delivery trigeminal and facial nerve palsy in a 38 yr old w oman recovered spontaneously with conservative therapy.