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Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report

Received: 31 October 2023     Accepted: 23 November 2023     Published: 6 December 2023
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Abstract

Spinal anesthesia is commonly used for various surgeries below the umbilicus including urological surgeries. Whereas many complications occur following administration of spinal anaesthesia such as hypotension, bradycardia, high spinal, post dural puncture headache, involuntary movement of the limbs is an extremely rare complication. It presents as a sudden shock-like involuntary muscle contractions affecting a single muscle or multiple muscle groups, which often resolves untreated. The characteristic of the presentation is different from those of typical myoclonus and the etiology is unclear. Here we presented a case of a 56-year-old known diabetic patient who developed jerky uncoordinated involuntary movements of the lower limbs with flexion at the hips after administration of spinal anaesthesia. These movements lasted 2-3 minutes, occurring without any form of stimulation in the limbs despite loss of sensation to the lower limbs. He was treated with iv ondansetron 8mg, iv hydrocortisone 200mg, iv chlorpheniramine 10mg. Symptoms improved after about 3 hours after induction of spinal anaesthesia with return sensory and purposeful motor function of the lower limbs. Involuntary movements of the lower limbs can occur unexpectedly following spinal anaesthesia in a diabetic patient. Anaesthestist should be mindful of this and be ready to manage the situation when it arises.

Published in International Journal of Anesthesia and Clinical Medicine (Volume 11, Issue 2)
DOI 10.11648/j.ijacm.20231102.20
Page(s) 115-118
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Spinal Anaesthesia, Lower Limbs, Involuntary Movement, Diabetes, Bupivacaine, Case Report

References
[1] Olawin AM, M Das J. Spinal Anesthesia. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537299/.
[2] Meng, T., Zhong, Z. and Meng, L. (2017), Impact of spinal anaesthesia vs. general anaesthesia on peri-operative outcome in lumbar spine surgery: a systematic review and meta-analysis of randomised, controlled trials. Anaesthesia, 72: 391-401.
[3] Apan A, Cuvaş Apan Ö. Complications in Spinal Anaesthesia [Internet]. Topics in Spinal Anaesthesia. InTech; 2014. Available from: http://dx.doi.org/10.5772/58817.
[4] Yun G, Kim E, Do W, Jung YH, Lee HJ, Kim Y. Transient involuntary movement disorder after spinal anesthesia: A case report. World J Clin Cases. 2021 Sep 16; 9(26): 7917-7922.
[5] Singhal, Suresh & Kaur, Kiranpreet & Singhla, Vishal. (2016). Myoclonus following spinal anaesthesia - case report of a rare complication. Sri Lankan Journal of Anaesthesiology. 24. 41. 10.4038/slja.v24i1.8106.
[6] Shiratori, T., Hotta, K., Satoh, M. et al. A case of spinal myoclonus in a patient with elective cesarean section. JA Clin Rep 4, 47 (2018).
[7] Bamgbade OA, Alfa JA, Khalaf WM, Zuokumor AP. Central neuraxial anaesthesia presenting with spinal myoclonus in the perioperative period: a case series. J Med Case Rep. 2009 Jun 23; 3: 7293.
[8] Nel L, Eren E. Peri-operative anaphylaxis. Br J Clin Pharmacol. 2011; 71(5): 647-58.
[9] Verlinde M, Hollmann MW, Stevens MF, Hermanns H, Werdehausen R, Lirk P. Local Anesthetic-Induced Neurotoxicity. Int J Mol Sci. 2016; 17(3): 339.
[10] Shimauchi, T., Yoshino, J. & Fujimura, N. A case of spinal nerve neurotoxicity with ropivacaine after combined spinal and epidural anesthesia. JA Clin Rep 7, 72 (2021).
[11] Markova L, Umek N, Horvat S, Hadžić A, Kuroda M, Pintarič TS, Mrak V, Cvetko E. Neurotoxicity of bupivacaine and liposome bupivacaine after sciatic nerve block in healthy and streptozotocin-induced diabetic mice. BMC Vet Res. 2020; 16(1): 247.
[12] Hebl JR, Kopp S L, Schroeder D R, Horlocker T T. Neurologic Complications After Neuraxial Anesthesia or Analgesia in Patients with Preexisting Peripheral Sensorimotor Neuropathy or Diabetic Polyneuropathy. Anesthesia & Analgesia 2006; 103(5): 1294-1299.
[13] Nakamoto T, Hirota K, Iwai T, Shingu K. Complete resolution of myoclonus-like involuntary movements under subarachnoid block after midazolam administration in a patient undergoing cesarean section: a case report. Korean J Anesthesiol. 2015. 68(2): 193-195.
[14] Sieffien W, Peng P, Dinsmore M. Spinal myoclonus following spinal anaesthesia in a patient with restless legs syndrome. Anaesth Rep. 2021 Apr 21; 9(1): 73-75.
[15] Dana K A, Dana Y A, Erum M S. Acute Opioid-Induced Myoclonic Reaction after Use of Fentanyl as an Anesthetic Drug for an Emergency Cesarean Section. Case Rep Neurol 4 October 2018; 10 (2): 130–134.
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Cite This Article
  • APA Style

    Nnanna Uchechukwu, A., Felicia, A., William Osebequin, A. (2023). Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report. International Journal of Anesthesia and Clinical Medicine, 11(2), 115-118. https://doi.org/10.11648/j.ijacm.20231102.20

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    ACS Style

    Nnanna Uchechukwu, A.; Felicia, A.; William Osebequin, A. Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report. Int. J. Anesth. Clin. Med. 2023, 11(2), 115-118. doi: 10.11648/j.ijacm.20231102.20

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    AMA Style

    Nnanna Uchechukwu A, Felicia A, William Osebequin A. Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report. Int J Anesth Clin Med. 2023;11(2):115-118. doi: 10.11648/j.ijacm.20231102.20

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  • @article{10.11648/j.ijacm.20231102.20,
      author = {Agwu Nnanna Uchechukwu and Asudo Felicia and Adeyemi William Osebequin},
      title = {Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report},
      journal = {International Journal of Anesthesia and Clinical Medicine},
      volume = {11},
      number = {2},
      pages = {115-118},
      doi = {10.11648/j.ijacm.20231102.20},
      url = {https://doi.org/10.11648/j.ijacm.20231102.20},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20231102.20},
      abstract = {Spinal anesthesia is commonly used for various surgeries below the umbilicus including urological surgeries. Whereas many complications occur following administration of spinal anaesthesia such as hypotension, bradycardia, high spinal, post dural puncture headache, involuntary movement of the limbs is an extremely rare complication. It presents as a sudden shock-like involuntary muscle contractions affecting a single muscle or multiple muscle groups, which often resolves untreated. The characteristic of the presentation is different from those of typical myoclonus and the etiology is unclear. Here we presented a case of a 56-year-old known diabetic patient who developed jerky uncoordinated involuntary movements of the lower limbs with flexion at the hips after administration of spinal anaesthesia. These movements lasted 2-3 minutes, occurring without any form of stimulation in the limbs despite loss of sensation to the lower limbs. He was treated with iv ondansetron 8mg, iv hydrocortisone 200mg, iv chlorpheniramine 10mg. Symptoms improved after about 3 hours after induction of spinal anaesthesia with return sensory and purposeful motor function of the lower limbs. Involuntary movements of the lower limbs can occur unexpectedly following spinal anaesthesia in a diabetic patient. Anaesthestist should be mindful of this and be ready to manage the situation when it arises. 
    },
     year = {2023}
    }
    

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    T1  - Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report
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    AB  - Spinal anesthesia is commonly used for various surgeries below the umbilicus including urological surgeries. Whereas many complications occur following administration of spinal anaesthesia such as hypotension, bradycardia, high spinal, post dural puncture headache, involuntary movement of the limbs is an extremely rare complication. It presents as a sudden shock-like involuntary muscle contractions affecting a single muscle or multiple muscle groups, which often resolves untreated. The characteristic of the presentation is different from those of typical myoclonus and the etiology is unclear. Here we presented a case of a 56-year-old known diabetic patient who developed jerky uncoordinated involuntary movements of the lower limbs with flexion at the hips after administration of spinal anaesthesia. These movements lasted 2-3 minutes, occurring without any form of stimulation in the limbs despite loss of sensation to the lower limbs. He was treated with iv ondansetron 8mg, iv hydrocortisone 200mg, iv chlorpheniramine 10mg. Symptoms improved after about 3 hours after induction of spinal anaesthesia with return sensory and purposeful motor function of the lower limbs. Involuntary movements of the lower limbs can occur unexpectedly following spinal anaesthesia in a diabetic patient. Anaesthestist should be mindful of this and be ready to manage the situation when it arises. 
    
    VL  - 11
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Author Information
  • Department of Anaesthesia and Intensive Care, University of Abuja Teaching Hospital (UATH) Gwagwalada, FCT Abuja, Nigeria

  • Department of Anaesthesia and Intensive Care, University of Abuja Teaching Hospital (UATH) Gwagwalada, FCT Abuja, Nigeria

  • Department of Anaesthesia and Intensive Care, Federal Teaching Hospital Lokoja (FTHL), Lokoja, Nigeria

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