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Pedigree analysis was done following which wife and two other kids were also found to be suffering from thalassemia minor.Routine investigations showed Hb - 12 g/d L, platelet - 190 × 10/L), neutrophil - 74%, renal function test were normal electrocardiogram (ECG)-within normal limits (WNL).
Arun Mathur Department of Anaesthesia and Critical Care, Kannur Medical College, Anjarakandy P.
O, Kannur - 670 612, Kerala India Source of Support: None, Conflict of Interest: None Subarachnoid block (SAB) is an extensively used regional anesthesia technique for many surgeries.
As power came to 4/5 in both LL in 4 h, we had decided to wait till morning.
Surprisingly, power in both limbs became 5/5 by morning.
Spinal needle was withdrawn and the second attempt tried in L2–L3 interspace after 4 min.
The second attempt was successful with free flow of CSF, although blood tinged.Next morning, patient's bilateral LL powers became normal (5/5). Damage to nerve roots of cauda equina following spinal anesthesia may occur due to compression caused by hematoma, inflammation, stretching due to abnormal position, direct trauma, and spinal ischemia or as a result of neurotoxicity of local anesthetics.While discharging after 3 days, we referred the patient to hematologist and neurosurgeon for further evaluation. Spinal hematoma following lumber puncture is associated with clotting disorders, either acquired (anticoagulant treatment) or congenital (hemophilia) or bleeding from a tumor or vascular malformation within the spinal canal.The most likely causes in our case could be hematoma, trauma or neurotoxicity to nerves leading to CES.As patient complained of back pain and leg pain postoperatively and examination revealed sensory and motor deficit.Within the next 4 h, power in both LLs increased to 4/5.As nearest higher referral center was 4 h drive, we managed patient conservatively in our hospital.Transient neurologic syndrome as differential diagnosis ruled out as it is exclusively a pain syndrome, as pain was present prolonged effect of block was also negated.Abnormal INR, sign, symptoms, examination findings, and blood tinged CSF at repeated lumber punctures goes in favor of hematoma causing CES.The patient was kept fasted overnight and planned to proceed under subarachnoid block (SAB).In the operation theater, routine monitors such as ECG, noninvasive blood pressure (BP), and pulse oximeter were attached.