Neurologic sequelae after caesarean section

Background: Because pregnancy increases the sensitivity of nervous tissue t o local anaesthetics, pregnant patients may be at higher risk of developing neurologic deficits after spinal block than non-pregnant patients. Therefo re, we evaluated prospectively the incidence and type of neurologic symptom s after spinal anaesthesia with hyperbaric bupivacaine for caesarean sectio n. Methods: In this prospective follow-up study we recorded neurologic complic ations during anaesthesia and postoperatively until discharge from the hosp ital of 219 patients, who underwent caesarean section under spinal anaesthe sia with hyperbaric bupivacaine (5 mg/ml, mean 13 mg). The patients filled in a questionnaire on the first and fifth postoperative days. In the case o f complaints typical of neurologic symptoms they were checked first by the anaesthesiologist and, in the case of persistent symptoms, afterwards addit ionally by a neurologist. Results: Twenty-six of 219 patients were not included in the further evalua tion because of incomplete return of their questionnaires. Seventeen mother s (8.8%) complained of transient neurologic symptoms (TNSs), lasting mostly 1-2 days, in the buttocks and/or legs during the first three postoperative days. Eleven patients (5.7%) complained of postdural puncture head-ache. T wo patients (emergency caesarean section because of protracted labour in on e and elective caesarean section because of previous caesarean section in t he other) complained of persisting pain or sensory abnormalities, Neither o f them felt paraesthesia during lumbar puncture. Conclusion: Women after caesarean section under a spinal block seem to suff er more often from TNSs than non-pregnant women. The conclusions are, howev er, uncertain since we had no control group operated on under other than sp inal anaesthesia. The persisting neurologic symptoms in two patients might also be due to the obstetric procedure itself. To find out about the validi ty and possible underlying causes of our results, we need randomised studie s with control groups receiving epidural or general anaesthesia.