Persistant paresthesia after spinal

[Laurel123]

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Anyone have any experiences with persistant paresthesia after a spinal.

I saw a patient recently who had a spinal about 4 days prior. She ws thin, but had some scoliosis (no instrumentation) She had a spinal placed and said that she did feel a zing down her right leg, but it was transient and disappeared immediately. Medication administered without issue. Spinal worked well.

Once it wore off, she noticed a deep throbbing pain in the sole of her right foot, but didn't think much of it.

However, after four days, the pain was persistant and she can't walk on it. There is no numbness or other change in sensation and no weakness. It seems to be localized to the sole of her foot. Sort of L5 distribution, though she denies any outer leg paresthesia or numbness.

Any thoughts? She was in lithotomy. I really wasn't sure if if could be related to the spinal.

 

[Bertelman]

What was the operation?

What level was the spinal placed?

What solution was used?

Could have been an injury from poor lithotomy position, too.

Is her only complaint pain on the plantar surface of the foot?

 

[Laurel123]

Bartholin cyst removal.
She requested spinal since she has really awful asthma.
25 g. pencil point with .75% bupivacaine (1.5ml) at L4-5 (or possibly L3-4)
Lithotomy for 1.5 hours.
She also has Marfans so she had numerous lower extremity surgeries and one leg is longer than the other.
No other complaints other than constant plantar foot pain. No numbness, no weakness, no lower leg symptoms.

 

[Licoricestick]

Reflexes?
Motor function?
Precise localisation of abnormal sensation?

 

[Laurel123]

Reflexes? INTACT
Motor function? ALL INTACT
Precise localisation of abnormal sensation? Entire plantar region of right foot. Deep burning pain. Not worse with palpation.

 

[core0]

Reflexes? INTACT
Motor function? ALL INTACT
Precise localisation of abnormal sensation? Entire plantar region of right foot. Deep burning pain. Not worse with palpation.

Any sweating, cooling or discoloration - sounds a lot like RSD.

David Carpenter, PA-C

 

[Noyac]

Any sweating, cooling or discoloration - sounds a lot like RSD.

David Carpenter, PA-C

RSD could be on its way. But the these signs don't have to be present this early for it not to be RSD (CRPS).

I say get an EMG and determine the level of the insult. Just reading so far, this could very well be from the spinal.

Start Lyrica.

 

[Planktonmd]

The absence of sensory or motor deficit makes it difficult to say that this is a nerve root injury.
This sounds more like a peripheral neuropathic type of pain and could be simply caused by placing the ankles in stirrups for a long time.
The best approach here is to wait and see, in the mean time I would treat this as neuropathic pain.
The good news is that most of these types of injuries resolve within 1 month.
In 2-3 Weeks if there is no improvement I would request a Neurologist consult and go from there.

 

[periopdoc]

I say get neurology involved now and get the studies so that you know what you are dealing with and how to proceed. Figure out where the injury is and determine the best course of treatment.

Or you could do what Plank says and 99% of the time it will resolve and you will have saved the system some money.

Personally, I would like the peace of mind knowing what the injury is, knowing that the patient is getting the best possible treatment if any treatment is indicated, and knowing whether this is a positioning or procedural complication.

- pod

 

[Gimlet]

I say get neurology involved now and get the studies so that you know what you are dealing with and how to proceed. Figure out where the injury is and determine the best course of treatment.

Or you could do what Plank says and 99% of the time it will resolve and you will have saved the system some money.

Personally, I would like the peace of mind knowing what the injury is, knowing that the patient is getting the best possible treatment if any treatment is indicated, and knowing whether this is a positioning or procedural complication.

- pod

I would guess that this approach would give you a better leg to stand on when this patient comes to you with a lawsuit for causing her CRPS, too, right?