How long is too long

[KungPOWChicken]

Had a case of a prolonged labor epidural block. Patient a one sided block from the get go after an easy placement in a healthy 30 y/o. Delivered in the am. Call from nurse in afternoon that leg is still numb and weak but can move foot. Weakness subsided finally at 15 hours. I’ve had plenty of patient’s with some residual numbness the next day and a few with prolonged weakness. These would always resolve and I would just monitor for 24 hours unless pain developed or the block worsened. What are other people doing?

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[Arch Guillotti]

Had a case of a prolonged labor epidural block. Patient a one sided block from the get go after an easy placement in a healthy 30 y/o. Delivered in the am. Call from nurse in afternoon that leg is still numb and weak but can move foot. Weakness subsided finally at 15 hours. I’ve had plenty of patient’s with some residual numbness the next day and a few with prolonged weakness. These would always resolve and I would just monitor for 24 hours unless pain developed or the block worsened. What are other people doing?

Watchful waiting.

 

[narcotics999]

Check if it is nerve root block or nerve block.

 

[KungPOWChicken]

Check if it is nerve root block or nerve block.

What exactly do you mean by this? I’ve always had a theory that when you get a one sided block you could have a paravertebral block or lumbar plexus block. I’ve had lumbar plexus blocks travel epidurally and affect the other leg so this makes sense and explains the longer block. I actually warn patients a one sided block may last longer. Any other thoughts?

 

[deleted162650]

What exactly do you mean by this?

Most post-partum neuropathies are peripheral and the result of extreme positioning during pushing or from the babies head moving through the pelvis. You need to perform a focused neuro exam to isolate the location of the deficit. The 2 most common are stretch injury to the sciatic or compression injury to the femoral - both from hyperflexion of the hips during pushing.

 

[KungPOWChicken]

Most post-partum neuropathies are peripheral and the result of extreme positioning during pushing or from the babies head moving through the pelvis. You need to perform a focused neuro exam to isolate the location of the deficit. The 2 most common are stretch injury to the sciatic or compression injury to the femoral - both from hyperflexion of the hips during pushing.

It was L3-l5 distribution. The fact that she had a dense block on the same side leads me to believe it was local anesthetic effect.

 

[Hoya11]

Most post-partum neuropathies are peripheral and the result of extreme positioning during pushing or from the babies head moving through the pelvis. You need to perform a focused neuro exam to isolate the location of the deficit. The 2 most common are stretch injury to the sciatic or compression injury to the femoral - both from hyperflexion of the hips during pushing.

agree with this. she had a dense block so she didnt feel it when her legs were in an unnatural position and caused transient deficit due to positioning

 

[fakin' the funk]

It was L3-l5 distribution. The fact that she had a dense block on the same side leads me to believe it was local anesthetic effect.

I assume you did what I'm gonna do, which is wave my hands and say that it has something to do with pooling on that side in the epidural space based on some sort of sub-sub-clinical anatomical abnormality. I love it.

 

[fakin' the funk]

agree with this. she had a dense block so she didnt feel it when her legs were in an unnatural position and caused transient deficit due to positioning

I think the point you're getting at is that the neuropathy occurs because of the COMBINATION of abnormal positioning and decreased sensation.

 

[dhb]

12''

 

[WholeLottaGame7]

12''

I'm kinda disappointed @SaltyDog didn't go there first. Slacking...

 

[deleted162650]

I'm kinda disappointed @SaltyDog didn't go there first. Slacking...

Sometimes you gotta let others grab the low-hanging fruit (see what I did there).

 

[drmwvr]

Had a case of a prolonged labor epidural block. Patient a one sided block from the get go after an easy placement in a healthy 30 y/o. Delivered in the am. Call from nurse in afternoon that leg is still numb and weak but can move foot. Weakness subsided finally at 15 hours. I’ve had plenty of patient’s with some residual numbness the next day and a few with prolonged weakness. These would always resolve and I would just monitor for 24 hours unless pain developed or the block worsened. What are other people doing?

unilateral anterior thigh numbness/weakness post delivery day one is pretty common. Would not call it "prolonged block" though...residual maybe...no big deal.

 

[Twiggidy]

Sometimes you gotta let others grab the low-hanging fruit (see what I did there).

 

[Consigliere]

View attachment 238717

It's Dexter St. Jock!

 

[Twiggidy]

It's Dexter St. Jock!

Con - Stant- lee