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EXTREME LOWER LIMB HYDROSIS AFTER AN OBSTETRIC LUMBAR EPIDURAL: A CONFUSION IN THE SYMPATHETIC CHAIN OR THE ANAESTHETIC BRAIN?
ESRA Academy. Roberts M. Sep 8, 2016; 138346; 0182 Topic: Complications in Obstetric Population
Dr. Mari Roberts
Dr. Mari Roberts

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Abstract
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Background and Aims:

A healthy 27 year old multiparous female presented for an elective Caesarian section. On history-taking, she reported an extremely unusual side effect after an epidural top-up for her first delivery. As a tertiary obstetric unit, with more than 4000 neuroaxial blocks per annum, we have never encountered it before and cannot fully explain it.

Methods:

4 years prior, the patient requested and received effective epidural analgesia during the first stage of spontaneous labour. It was then successfully “topped-up” for her subsequent Caesarian section, using 20 mls of 0.5% Levbupivacaine and 100mcg of Fentanyl. Her sensorimotor function was completely restored after 6 hours.

Results:

Upon returning home, the patient and her husband noticed that she started to experience profuse, nocturnal, symmetrical sweating and warmth of both legs. She was required to dry her legs and change bedding every morning. This continued daily for 3 months, whereupon it spontaneously resolved. There were no neurological signs.

A subarachnoid block was performed for her second Caesarian section, with no recurrence.

Conclusions:

There are no published case reports of this novel symptom. Our surgical colleagues at the Royal College of Obstetrics & Gynaecology (UK) know of no operative causes. However, several mothers on social media websites suggest similar experiences following their obstetric epidurals.

One theory is that the top-up mixture causes a chemical, prolonged but temporary lumbar sympathectomy, leading to “Compensatory Sweating”. This phenomenon is recognised as a possible, but distressingly permanent, complication of surgical sympathectomies, performed for hyperhidrosis.

We seek to highlight this potential problem.

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