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Problems arise from spinal anaesthesia

11 March 2019

A 45-year-old woman underwent an abdominal hysterectomy for fibroids. The consultant anaesthetist induced general anaesthesia before performing a spinal anaesthetic at L3/4. The surgery was uncomplicated, although the claimant’s blood pressure was low throughout the operation.

Postoperatively the claimant complained of persisting numbness and weakness to her left leg, preventing mobilisation. An MRI suggested inflammation in the distal thoracic cord and conus. The cause was unclear but suspected to be related to the spinal anaesthesia.

After four months a claim was made against the consultant anaesthetist. The patient’s motor power improved to the extent that she was able to walk, but she continued to have sensory loss and had a constant burning pain in her leg.

The anaesthetic expert witness considered that the cause of the patient’s symptoms and changes on the MRI was related to the spinal anaesthesia. As the claimant had been hypotensive throughout the surgery the most likely mechanism was ischaemia of the spinal cord, although trauma could not be excluded. The case was settled because: 

• The record keeping by the anaesthetist was very poor and lacked crucial details such as the size and type of spinal needle, the use of aseptic precautions and the use of intravenous fluids or vasopressors.

• There was no record of a discussion with the patient about the risks and benefits of spinal anaesthesia.

• The blood pressure recorded on the ward prior to the patient arriving at the anaesthetic room was high, and intraoperatively the blood pressure was permitted to fall and remain low throughout the surgery. 

• There was no evidence that the anaesthetist was aware of preoperative hypertension, and no blood pressure reading was taken immediately prior to induction of anaesthesia.

The case was settled for a substantial amount due to ongoing pain, change in sensation and functional difficulties.

This case is based on a real scenario, with some facts altered to preserve confidentiality.