Lumbosacral plexus injury following vaginal delivery with epidural analgesia -A case report-

Abstract

A 26 year old, healthy, 41 week primiparous woman received a patient-controlled epidural analgesia (PCEA) and experienced paraplegia 11 hours later after a vaginal delivery. This was thought to be the result of complications from PCEA but there was no specific abnormality on magnetic resonance imaging (MRI) of the lumbosacral spine. On an electromyography (EMG) study performed 15 days following delivery, signs of tibial neuropathy were present and peripheral nerve injury during vaginal delivery was suspected. Motor weakness and hypoesthesia of both lower extremities improved rapidly, but a decrease in the desire to urinate or defecate, followed by urinary incontinence and constipation persisted, We suspected the sacral plexus had been severely damaged during vaginal delivery. Seven months later, the patient's conditions improved but had not fully recovered.

Keywords: Analgesia; Epidural; Lumbosacral plexus; Obstetric delivery.

Fig. 1

Lumbosacral MRI (Postpartum 0 day). Sagittal (A) and axial (B) images of T2-weighted lumbosacral MRI show L3 through L5 intervertebral discs protrusion (central to left central) and associated air bubbles (white arrows), posterior epidural space - related to previous epidural catheterization.

Fig. 2

Whole spine MRI (Postpartum 2 day). Whole spine MRI shows L3 through L5 intervertebral discs protrusion (central to left central), intervertebral disc bulging from C6 to C7, and associated air bubbles, posterior epidural space - related to previous epidural catheterization.

Fig. 3

Defecogram. Defecogram at rest (A), squeezing (B), straining (C) and defecation (D). The anorectal angle (ARA) is measured between the anal canal and the central longitudinal axis of the lower rectum. ARA decreased when squeezing (B), however not enough to reach normal values. Also, a tendency for proctocolic intussusceptions was observed when defecating (D).