Convulsions following axillary brachial plexus blockade with levobupivacaine

Neurotoxicity manifesting as convulsions is a recognised complication of the administration of local anaesthetic drugs as part of a regional anaesthetic technique. We describe a case of self-limiting convulsions following the institution of an axillary brachial plexus block with levobupivacaine. Although the occurrence of convulsions following the administration of racemic bupivacaine is a well-recognised complication, there have been no clinical case reports published describing convulsions following the use of levobupivacaine in regional anaesthesia.     

Accidental dural puncture and post dural puncture headache in obstetric anaesthesia: presentation and management: a 23-year survey in a district general hospital

Post dural puncture headache can be a debilitating complication of epidural and subarachnoid anaesthesia for a new mother. In a survey of 18 337 epidurals and 5021 subarachnoid blocks performed for obstetric procedures over a 23-year period in a district general hospital maternity unit, there were 167 recognised accidental dural punctures after epidurals (0.91%), with 147 patients (88%) developing post dural puncture headache. In addition there were 52 post dural puncture headaches after subarachnoid blocks (1.04%). Successful management of accidental dural puncture and post dural puncture headache requires adherence to clear policies and protocols, with close follow-up of patients by an experienced obstetric anaesthetist.     

Dural puncture: the patients' perspective A patient survey of cases at a DGH maternity unit 1983–1993

Background: This study was designed to investigate the patient experience following accidental dural puncture complicating obstetric epidural analgesia.
Methods: Sixty-three patients who had suffered from accidental dural puncture during obstetric epidural analgesia over a ten-year period were sent a questionnaire enquiring about their experiences. 68% responded.
Results: Headache was the most severe symptom, occurring in 86% of this group; it lasted for a median of eight days and recurred after discharge in 47%. Backache occurred in 70% and 58% suffered with backache following discharge.
Headache was considered to be the worst aspect by 49% of responders, backache by 19% and bedrest by 33%. Bed rest was frequently voluntary (as opposed to being enforced on medical orders) since many patients only gained relief from their headache when supine.
Twenty patients (47%) received a blood patch, which was effective in relieving headache in 14 patients; however, the headache recurred after discharge in 10 of these 14 patients. Only 8 patients (19%) stated that they were aware of the risk of dural puncture prior to their epidural, three of whom were members of paramedical professions.
Conclusions: Headache and backache are both common following dural puncture with a 16G needle and both frequently recur after discharge from hospital. It was the strongly expressed opinion of this selected group that all mothers should be warned of the risk of dural puncture before undergoing epidural analgesia.     

Textbook of Obstetric Anaesthesia.

Some books say ‘read me’, and I think this is oneof them. The excellent opening chapter on the history of obstetricanaesthesia foretells a book that is interesting, informative,and stimulating. It is an attractive book that has been carefullyillustrated. Each chapter has an introductory index, which makesit easy to find what you are looking for, whether you are aspecialist registrar in the run up to the Final FRCA, or a DGHobstetric anaesthetist wanting to know how to handle a problem.It is a book that would also be useful for a     

Case report: high sympathetic block with ptosis after lumbar epidural analgesia in an obstetric patient

Following lumbar epidural analgesia, a 26 year old primigravida developed right ptosis and other signs of paralysis of the right sympathetic supply to the head and neck. The case is discussed and compared with cases of Horner's syndrome which have followed epidural analgesia. It was probably due to differential sympathetic blockade.     

A reply to Joseph Bernstein.

Dr. Bernstein suggests that anti-vivisectionists should be able to fill in a directive requesting that they receive no medical treatment developed through work on animals. It is replied that this would only be reasonable if research not using animals had long been funded as adequately and its results were currently available.