گزارش مورد: گزارش يك مورد نادر سندرم كودا اكينا پس از بيهوشي داخل نخاعي با ماركائين 5/ %

Case Report: A case of rare Cauda Equina syndrome after spinal anesthesia with marcaine 0.5%.

Cauda equina syndrome is a sign and symptom of end tail spinal cord damage. Urinary retention and fecal incontinency, the results of sacral roots injury; are its complains. Mechanical (spinal cord trauma and chemical agents (intrathecal drugs) are the most important causes. In this article, a patient whom involved after spinal anesthesia is reported. A 46 -year -old woman underwent spinal anesthesia with 3.5 ml marcaine 0.5% for right hip bipolar arthroplasty. She had a past medical history of head trauma and seizure in childhood that controlled with phenobarbital and carbamazepine, partially. The spinal anesthesia technique was done correctly and a desirable anesthesia achieved until the end of surgery. Then she was involved with urinary retention and fecal incontinency after surgery. Lumbosacral and brain magnetic resonance imaging was normal but the electro-myogram and neuron physiologic study of anus showed bilateral severe axonotometic damage from S-2 till L-5 roots. Her diagnosis was Cauda equina syndrome. Defecation control was recovered after 45 days and bladder function was cured after 55 days, fortunately. This syndrome is a very rarely complication of local anesthetics because they are neurotxic agents. The neurotoxicity of local anesthetics was established in animals and in-vitro studies, previously. While in other reports the neurotoxicity of lidocaine is more than bupivacaine. The rate of neurologic damage in spinal anesthesia is more reported than epidural anesthesia. The anesthetist must be consider the etiology of prolonged impairment sensation, paralysis and or sphincter function after spinal anesthesia (such as hematoma, abscess, epidural tumor herniation or drug side effect); diagnosis maters (history, physical examination, imaging, neurophysiologic study etc.) and treatment.