PROLONGED BLOCK WITH RECOVERY AFTER EXTRADURAL ANALGESIA FOR LABOUR

A patient had a prolonged block after continuous extradural analgesia in labour. The block was unilateral, but 60 min after a second block there was bilateral sensory and motor loss. The original unblocked side did not recover fully until more than 60 hr. The local anaesthetic agent was 18 ml of bupivacaine 0.5 % plain. Extradural analgesia for the relief of pain in labour has become widely practised in recent years especi-ally since the introduction of the long-acting local analgesic bupivacaine. As neurological complica-tions are the most feared consequence of this tech-nique, it is a matter of concern should the nerve block outlast its expected duration. CASE REPORT A 26-year-old patient who had been pregnant twice previously presented in labour. During her first delivery she had pethidine for the relief of pain; a vacuum extraction was necessary under general anaesthesia. In her second labour she had a spon-taneous vaginal delivery with nitrous oxide in oxy-gen (Entonox) for analgesia. However, she was not satisfied with the pain relief obtained from either pethidine or nitrous oxide in her previous labours, and after an explanation of extradural block and its possible complications she decided upon this method. Her pregnancy had been normal and physical examination revealed no abnormality. The patient was positioned on her left side. Using a Tuohy needle and an air-filled syringe, the extradural space was located at the L2-L3 inter-space by the loss of resistance method. About 4 ml of air was injected. During insertion of a Portex catheter to 15 cm, she complained of a mild cramp-like pain down her right leg. The catheter was withdrawn to 10 cm from the skin, leaving 4-5 cm in the extradural space. A Millipore filter unit (Swinnex 13) was connected, and after ensuring that no blood or c.si. could be aspirated 5 ml of bupivacaine 0.5 % plain was injected. Five min later she was turned on to her right side and another 5 ml of bupivacaine 0.5 % plain was injec