Kose Kamil Cagri, Cebesoy Oguz, Karadeniz Engin, Bilgin Sinan
Department of Orthopaedics and Traumatology, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey.
MedGenMed. 2005 Oct 17;7(4):15.
Paralysis of abducens nerve is a very rare complication of lumbar puncture, which is a common procedure most often used for diagnostic and anesthetic purposes.
A 38-year-old man underwent surgery for a left hallux valgus while he was under spinal anesthesia. On the first postoperative day, the patient experienced a severe headache that did not respond to standard nonsteroidal anti-inflammatory medication and hydration. During the second postoperative day, nausea and vomiting occurred. On the fourth postoperative day, nausea ceased completely but the patient complained of diplopia. Examination revealed bilateral strabismus with bilateral abducens nerve palsy. His diplopia resolved completely after 9 weeks and strabismus after 6 months.
Abducens palsy following spinal anesthesia is a rare and reversible complication. Spinal anesthesia is still a feasible procedure for both the orthopaedic surgeon and the patient. Other types of anesthesia or performing spinal anesthesia with smaller diameter or atraumatic spinal needles may help decrease the incidence of abducens palsy. Informing the patient about the reversibility of the complication is essential during the follow-up because the palsy may last for as long as 6 months. Special attention must be paid to patient positioning following the operation. Recumbency and lying flat should be accomplished as soon as possible to prevent cerebrospinal fluid leakage and resultant intracranial hypotension. This becomes much more important if the patient has postdural puncture headache.
外展神经麻痹是腰椎穿刺极为罕见的并发症，而腰椎穿刺是一种最常用于诊断和麻醉目的的常见操作。
一名38岁男性在脊髓麻醉下行左拇外翻手术。术后第一天，患者出现严重头痛，标准的非甾体类抗炎药和补液治疗无效。术后第二天，出现恶心和呕吐。术后第四天，恶心完全缓解，但患者主诉复视。检查发现双侧斜视伴双侧外展神经麻痹。9周后复视完全消失，6个月后斜视消失。
脊髓麻醉后外展神经麻痹是一种罕见且可逆的并发症。脊髓麻醉对骨科医生和患者来说仍是一种可行的操作。其他类型的麻醉或使用直径较小或无创伤的脊髓穿刺针进行脊髓麻醉可能有助于降低外展神经麻痹的发生率。在随访期间告知患者该并发症的可逆性至关重要，因为麻痹可能持续长达6个月。术后必须特别注意患者的体位。应尽快让患者平卧，以防止脑脊液漏出及由此导致的颅内低压。如果患者有硬膜穿刺后头痛，这一点就更为重要。
