Prolonged spinal myoclonus following spinal anaesthesia with bupivacaine

Abstract

Spinal myoclonus occurring after spinal anaesthesia is very rare and characterised by sudden involuntary jerks of the back and limbs. A 34 year old male without any comorbidities underwent a subarachnoid block with bupivacaine heavy for laminectomy of L4-L5. Within minutes he developed pain and severe myoclonic jerks of lower back radiating to lower and upper limbs which lasted for 48 hours. Another 65 year old obese lady, known diabetic and hypertensive who presented for a percutaneous nephrolithotomy underwent an epidural catheter placement at L2-L3 and a subarachnoid block with bupivacaine heavy at L3-L4. Within minutes she developed severe myoclonic jerks of the lower limbs and back radiating to upper limbs which again lasted for 48 hours. Both cases ofprolonged acute propriospinal myoclonus following subarachnoid block occurred within a period of six months at a tertiary care centre and were managed with sedation, muscle relaxation, mechanical ventilation and anti epileptics.

Keywords

• Spinal Myoclonus
• Bupivacaine adverse effects
• Spinal Anaesthesia Key Message: Propriospinal myoclonus though rare
• can present acutely after spinal anaesthesia with bupivacaine and be severe enough to warrant sedation
• muscle relaxation
• mechanical ventilation and medication with anti epileptics.