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Q: health ( Answered,   0 Comments )
Subject: health
Category: Health > Medicine
Asked by: rosellen-ga
List Price: $25.00
Posted: 30 Jun 2006 02:31 PDT
Expires: 30 Jul 2006 02:31 PDT
Question ID: 742281
I have had 2 spinal blocks in the last 2 months, one to have removed a
large benign neuroma from my left foot, after which there were no
problems and the 2nd block 2 weeks ago for 'patching up' my left knee
via an arthroscopy. The first few days were great, but painful
muscles, hardness of muscles, swelling then began to affect my whole
left leg. After a doppler test for any possible clots was negative,
the orthopedic specialist has put it down to just post-operative pain.
However, I'm used to pain after years of probable myotonic dystrophpy
and just can't accept that diagnosis. Can a spinal block cause such an
aftermath? I just want to know with which kind of specialist I should
next make my appointment and whether the block or something else could
be the cause. I am in my mid 60's. For various reasons, I am in quite
a hurry to resolve this problem.
Thank-you very much.
Subject: Re: health
Answered By: boquinha-ga on 30 Jun 2006 11:20 PDT
Hello rosellen-ga!

I am sorry to hear that you?ve been having so much difficulty lately.
I really hope that you are able to get the help that you need soon. Of
course my research is in no way intended to substitute for the opinion
of a qualified health care practitioner. I would encourage you to
discuss any and all questions and concerns that you may have with a
qualified health professional that you trust. With that said, here is
what I?ve found!

- - - - - - - - - - - - - - - - - - - -


In an article from ?Mayo Clinic Proceedings,? it suggests that pain
such as you are describing can occur after spinal blocks.

?Available studies suggest a risk of persistent lumbosacral neuropathy
after spinal lidocaine by single injection in about 1 in 1300
procedures and a risk as high as about 1 in 200 after continuous
spinal anesthesia with lidocaine. While uncommon, this risk is
probably an order of magnitude higher than the risk reported for other
commonly used LAs [local anesthetics] or for general anesthesia.
Spinal lidocaine is also implicated in the syndrome of transient
neurologic symptoms (previously referred to as transient radicular
irritation), manifest by pain . . . in the buttocks or legs after
recovery from anesthesia. Although the pain typically resolves within
1 week without lasting sequelae, it can be severe in up to one third
of patients with the syndrome.?

A paper found on the American Society of Regional Anesthesia and Pain
Medicine website discusses Transient Neurological Symptoms (TNS) and
notes that its incidence varies depending upon the position into which
the patient is placed for surgery. The article also discusses the
various causes and effects of TNS.

?Patients undergoing surgery in the lithotomy position have an
incidence of TNS of approximately 30% to 36%, patients undergoing
arthroscopic knee surgery an incidence of 18% to 22%, and patients
undergoing surgery in the supine position an incidence of 4% to 8%.?

A 2001 study looking at adults receiving spinal anesthesia for a
variety of procedures found that transient radicular irritation
(TRI)?a condition that could present with symptoms such as yours?is a
legitimate side effect that happens regularly enough that it should be
discussed with patients prior to a procedure.,M

In an article on the website of the Anesthesia Patient Safety Forum,
it discusses the high incidence of transient leg pain after receiving
a spinal block.

?The incidence of transient leg, buttock, and back pain is
distressingly high after spinal block with lidocaine.?

An article that appeared in the ?British Journal of Anaesthesiology?
discussed the varied effects of spinal blocks using lidocaine. It is
suggested that there are a number of effects, including TRI that can
be attributed to lidocaine?s use.

This abstract is from ?Masui: The Japanese journal of anesthesiology?
and discusses a small study performed in leprosy patients. Seven of 20
patients studied developed leg pain after spinal anesthesia.

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While it certainly seems reasonable given the timing of your symptoms
with your recent spinal blocks that this pain and swelling are side
effects of your procedures, there are a number of other conditions
that could also cause the pain you are describing. One is blood clots,
but it sounds as though your physician has already thought of this and
ruled it out. Here is a list of potential reasons to consider.

The MedlinePlus website, maintained by the National Library of
Medicine and National Institute of Health has an article about the
various causes of leg pain.

* Muscle fatigue
* Dehydration
* Low potassium, sodium, calcium, magnesium
* Medications, especially diuretics or statins (ex. Lipitor, Zocor)
* Torn or strained muscle
* Tendonitis
* Shin splints
* Stress fracture
* Blood clot
* Claudication (crampy pain with activity). This is due to
insufficient blood flow to the muscles, usually caused by cholesterol
* Arthritis
* Nerve damage
* Infection of the bone or skin
* Varicose veins
* Sciatic nerve pain

The following information comes from 

?Leg swelling generally occurs because of an abnormal accumulation of
fluid in the tissues of the lower extremity. The medical term for leg
swelling from excessive fluid in the tissues is edema. Persisting
indentation of a swollen leg after pressure from a finger is known as
pitting edema.?

Here are some causes of swelling that the article goes on to mention.

* Baker Cyst
* Cellulitis
* Cirrhosis of the liver
* Congestive Heart Failure (CHF)
* Eosinophilic Fasciitis
* Kidney Failure
* Scleroderma
* Idiopathic Edema (unknown cause, usually in women)
* Leg vein obstruction
* Medications
* Nephrotic syndrome
* Salt retention
* Trauma
* Phlebitis

I?ve included a few more links to articles about leg pain and
swelling. You can look at these and discuss any further concerns or
questions you may have with your own physician as needed.

Here is an article about spinal stenosis as one cause of leg pain.

This is a Mayo Clinic article about claudication, a common cause of leg pain.

Here is another article about the causes of leg swelling.

This is an article with not only a list of causes, but also some
treatment options for leg pain.

This site has a rather extensive list of the causes of leg pain, as
well as a detailed list of medications that can cause leg pain.

- - - - - - - - - - - - - - - - - - - -


According to the American Society of Regional Anesthesia and Pain
Medicine, there are a number of possible treatments for TNS. They
note, however, that with time it is a temporary condition in most

?One of the most successful classes of drugs for treating TNS has been
the NSAIDs [non-steroidal anti-inflammatory drugs]. Patients generally
report good pain relief with these drugs. Ibuprofen, naproxen, and
ketorolac have all been used successfully. If significant muscle spasm
is an accompanying component of TNS, patients may experience
therapeutic benefit from the addition of muscle relaxants, such as
cyclobenzaprine. Symptomatic therapy, including leg elevation on
pillows and heating pads, may provide an additional measure of patient

They also mention trigger point injections as another possible treatment.

I discussed your question with my husband who is a physician, and
asked his opinion (again, remember that this opinion is not a
substitute for being evaluated in person by a qualified practitioner).
He says that because so many conditions can give you similar symptoms,
it would be a good idea to be seen by a qualified general practitioner
(either a family physician or internist). A GP would be able to hear
your history, examine you, and order appropriate tests. He or she
could then refer you to an appropriate specialist for further
evaluation and testing if needed. If this is a nerve problem stemming
from your spinal block, my husband says that a general practitioner
could definitely prescribe the above-mentioned treatments and if that
fails, a neurologist would probably be the best specialist to see you

- - - - - - - - - - - - - - - - - - - -

I hope that you find this information to be useful. Again, be sure to
discuss your specific questions and concerns with either your own
personal physician or another qualified health professional that you
trust. I hope that you find a solution to everything soon. If you have
need of any further clarification, please let me know how I can help.
Good luck!


Search strategy:

Online research
Discussion with my physician husband

Search terms:

Spinal block sequelae
Spinal block effects
?leg pain? causes
"leg swelling" causes
"spinal block" "leg pain"
lidocaine radiculopathy
transient radicular irritation
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