Eye Problem Following Foot Surgery -- Abducens Palsy as a Complication of Spinal Anesthesia

Kamil Cagri Kose, MD; Oguz Cebesoy, MD; Engin Karadeniz, MD; Sinan Bilgin, MD

Disclosures

October 17, 2005

Conclusion

Abducens palsy following spinal anesthesia is a rare and reversible complication. Spinal anesthesia is still a feasible choice for both the orthopaedic surgeon and the patient. But to decrease the incidence of this complication, other types of anesthesia may also be used (such as general with laryngeal mask, peripheral nerve block with sedation, etc). If this complication occurs, patience and informing the patient about reversibility are essential during the follow-up, because the palsy may last as long as 6 months.

Atraumatic needles with side holes such as Sprott or Whitacre needles or smaller dimension Quincke type needles may be used during spinal anesthesia to decrease the incidence of PLPH.

Special attention must be paid to patient positioning following the operation. Recumbency and lying flat should be accomplished as soon as possible to prevent CSF leakage and resultant intracranial hypotension. This becomes much more important if the patient has postdural puncture headache.

Epidural blood patching can be routinely applied if large needles are used, and if multiple needle insertions are made to the subarachnoid region, because these may increase the incidence of both PLPH and abducens palsy.

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