Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report

Agwu Nnanna Uchechukwu; Asudo Felicia; Adeyemi William Osebequin

doi:doi:10.11648/j.ijacm.20231102.20

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Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report

Agwu Nnanna Uchechukwu, Asudo Felicia, Adeyemi William Osebequin

Published in International Journal of Anesthesia and Clinical Medicine (Volume 11, Issue 2)

Received: 31 October 2023 Accepted: 23 November 2023 Published: 6 December 2023

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Abstract

Spinal anesthesia is commonly used for various surgeries below the umbilicus including urological surgeries. Whereas many complications occur following administration of spinal anaesthesia such as hypotension, bradycardia, high spinal, post dural puncture headache, involuntary movement of the limbs is an extremely rare complication. It presents as a sudden shock-like involuntary muscle contractions affecting a single muscle or multiple muscle groups, which often resolves untreated. The characteristic of the presentation is different from those of typical myoclonus and the etiology is unclear. Here we presented a case of a 56-year-old known diabetic patient who developed jerky uncoordinated involuntary movements of the lower limbs with flexion at the hips after administration of spinal anaesthesia. These movements lasted 2-3 minutes, occurring without any form of stimulation in the limbs despite loss of sensation to the lower limbs. He was treated with iv ondansetron 8mg, iv hydrocortisone 200mg, iv chlorpheniramine 10mg. Symptoms improved after about 3 hours after induction of spinal anaesthesia with return sensory and purposeful motor function of the lower limbs. Involuntary movements of the lower limbs can occur unexpectedly following spinal anaesthesia in a diabetic patient. Anaesthestist should be mindful of this and be ready to manage the situation when it arises.

Published in	International Journal of Anesthesia and Clinical Medicine (Volume 11, Issue 2)
DOI	10.11648/j.ijacm.20231102.20
Page(s)	115-118
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Spinal Anaesthesia, Lower Limbs, Involuntary Movement, Diabetes, Bupivacaine, Case Report

References

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[2]	Meng, T., Zhong, Z. and Meng, L. (2017), Impact of spinal anaesthesia vs. general anaesthesia on peri-operative outcome in lumbar spine surgery: a systematic review and meta-analysis of randomised, controlled trials. Anaesthesia, 72: 391-401.
[3]	Apan A, Cuvaş Apan Ö. Complications in Spinal Anaesthesia [Internet]. Topics in Spinal Anaesthesia. InTech; 2014. Available from: http://dx.doi.org/10.5772/58817.
[4]	Yun G, Kim E, Do W, Jung YH, Lee HJ, Kim Y. Transient involuntary movement disorder after spinal anesthesia: A case report. World J Clin Cases. 2021 Sep 16; 9(26): 7917-7922.
[5]	Singhal, Suresh & Kaur, Kiranpreet & Singhla, Vishal. (2016). Myoclonus following spinal anaesthesia - case report of a rare complication. Sri Lankan Journal of Anaesthesiology. 24. 41. 10.4038/slja.v24i1.8106.
[6]	Shiratori, T., Hotta, K., Satoh, M. et al. A case of spinal myoclonus in a patient with elective cesarean section. JA Clin Rep 4, 47 (2018).
[7]	Bamgbade OA, Alfa JA, Khalaf WM, Zuokumor AP. Central neuraxial anaesthesia presenting with spinal myoclonus in the perioperative period: a case series. J Med Case Rep. 2009 Jun 23; 3: 7293.
[8]	Nel L, Eren E. Peri-operative anaphylaxis. Br J Clin Pharmacol. 2011; 71(5): 647-58.
[9]	Verlinde M, Hollmann MW, Stevens MF, Hermanns H, Werdehausen R, Lirk P. Local Anesthetic-Induced Neurotoxicity. Int J Mol Sci. 2016; 17(3): 339.
[10]	Shimauchi, T., Yoshino, J. & Fujimura, N. A case of spinal nerve neurotoxicity with ropivacaine after combined spinal and epidural anesthesia. JA Clin Rep 7, 72 (2021).
[11]	Markova L, Umek N, Horvat S, Hadžić A, Kuroda M, Pintarič TS, Mrak V, Cvetko E. Neurotoxicity of bupivacaine and liposome bupivacaine after sciatic nerve block in healthy and streptozotocin-induced diabetic mice. BMC Vet Res. 2020; 16(1): 247.
[12]	Hebl JR, Kopp S L, Schroeder D R, Horlocker T T. Neurologic Complications After Neuraxial Anesthesia or Analgesia in Patients with Preexisting Peripheral Sensorimotor Neuropathy or Diabetic Polyneuropathy. Anesthesia & Analgesia 2006; 103(5): 1294-1299.
[13]	Nakamoto T, Hirota K, Iwai T, Shingu K. Complete resolution of myoclonus-like involuntary movements under subarachnoid block after midazolam administration in a patient undergoing cesarean section: a case report. Korean J Anesthesiol. 2015. 68(2): 193-195.
[14]	Sieffien W, Peng P, Dinsmore M. Spinal myoclonus following spinal anaesthesia in a patient with restless legs syndrome. Anaesth Rep. 2021 Apr 21; 9(1): 73-75.
[15]	Dana K A, Dana Y A, Erum M S. Acute Opioid-Induced Myoclonic Reaction after Use of Fentanyl as an Anesthetic Drug for an Emergency Cesarean Section. Case Rep Neurol 4 October 2018; 10 (2): 130–134.
[16]	Asamaporn P, Amornpojnimman T. Spinal Myoclonus after Spinal Anaesthesia. J Health Sci Med Res 2022; 40(5): 585-588.

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Nnanna Uchechukwu, A., Felicia, A., William Osebequin, A. (2023). Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report. International Journal of Anesthesia and Clinical Medicine, 11(2), 115-118. https://doi.org/10.11648/j.ijacm.20231102.20

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ACS Style

Nnanna Uchechukwu, A.; Felicia, A.; William Osebequin, A. Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report. Int. J. Anesth. Clin. Med. 2023, 11(2), 115-118. doi: 10.11648/j.ijacm.20231102.20

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AMA Style

Nnanna Uchechukwu A, Felicia A, William Osebequin A. Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report. Int J Anesth Clin Med. 2023;11(2):115-118. doi: 10.11648/j.ijacm.20231102.20

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@article{10.11648/j.ijacm.20231102.20,
  author = {Agwu Nnanna Uchechukwu and Asudo Felicia and Adeyemi William Osebequin},
  title = {Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {11},
  number = {2},
  pages = {115-118},
  doi = {10.11648/j.ijacm.20231102.20},
  url = {https://doi.org/10.11648/j.ijacm.20231102.20},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20231102.20},
  abstract = {Spinal anesthesia is commonly used for various surgeries below the umbilicus including urological surgeries. Whereas many complications occur following administration of spinal anaesthesia such as hypotension, bradycardia, high spinal, post dural puncture headache, involuntary movement of the limbs is an extremely rare complication. It presents as a sudden shock-like involuntary muscle contractions affecting a single muscle or multiple muscle groups, which often resolves untreated. The characteristic of the presentation is different from those of typical myoclonus and the etiology is unclear. Here we presented a case of a 56-year-old known diabetic patient who developed jerky uncoordinated involuntary movements of the lower limbs with flexion at the hips after administration of spinal anaesthesia. These movements lasted 2-3 minutes, occurring without any form of stimulation in the limbs despite loss of sensation to the lower limbs. He was treated with iv ondansetron 8mg, iv hydrocortisone 200mg, iv chlorpheniramine 10mg. Symptoms improved after about 3 hours after induction of spinal anaesthesia with return sensory and purposeful motor function of the lower limbs. Involuntary movements of the lower limbs can occur unexpectedly following spinal anaesthesia in a diabetic patient. Anaesthestist should be mindful of this and be ready to manage the situation when it arises. 
},
 year = {2023}
}

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TY  - JOUR
T1  - Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report
AU  - Agwu Nnanna Uchechukwu
AU  - Asudo Felicia
AU  - Adeyemi William Osebequin
Y1  - 2023/12/06
PY  - 2023
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DO  - 10.11648/j.ijacm.20231102.20
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 115
EP  - 118
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20231102.20
AB  - Spinal anesthesia is commonly used for various surgeries below the umbilicus including urological surgeries. Whereas many complications occur following administration of spinal anaesthesia such as hypotension, bradycardia, high spinal, post dural puncture headache, involuntary movement of the limbs is an extremely rare complication. It presents as a sudden shock-like involuntary muscle contractions affecting a single muscle or multiple muscle groups, which often resolves untreated. The characteristic of the presentation is different from those of typical myoclonus and the etiology is unclear. Here we presented a case of a 56-year-old known diabetic patient who developed jerky uncoordinated involuntary movements of the lower limbs with flexion at the hips after administration of spinal anaesthesia. These movements lasted 2-3 minutes, occurring without any form of stimulation in the limbs despite loss of sensation to the lower limbs. He was treated with iv ondansetron 8mg, iv hydrocortisone 200mg, iv chlorpheniramine 10mg. Symptoms improved after about 3 hours after induction of spinal anaesthesia with return sensory and purposeful motor function of the lower limbs. Involuntary movements of the lower limbs can occur unexpectedly following spinal anaesthesia in a diabetic patient. Anaesthestist should be mindful of this and be ready to manage the situation when it arises. 

VL  - 11
IS  - 2
ER  -

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Author Information

Agwu Nnanna Uchechukwu

Department of Anaesthesia and Intensive Care, University of Abuja Teaching Hospital (UATH) Gwagwalada, FCT Abuja, Nigeria

Contact Email
Asudo Felicia

Department of Anaesthesia and Intensive Care, University of Abuja Teaching Hospital (UATH) Gwagwalada, FCT Abuja, Nigeria
Adeyemi William Osebequin

Department of Anaesthesia and Intensive Care, Federal Teaching Hospital Lokoja (FTHL), Lokoja, Nigeria

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APA Style

Nnanna Uchechukwu, A., Felicia, A., William Osebequin, A. (2023). Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report. International Journal of Anesthesia and Clinical Medicine, 11(2), 115-118. https://doi.org/10.11648/j.ijacm.20231102.20

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ACS Style

Nnanna Uchechukwu, A.; Felicia, A.; William Osebequin, A. Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report. Int. J. Anesth. Clin. Med. 2023, 11(2), 115-118. doi: 10.11648/j.ijacm.20231102.20

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AMA Style

Nnanna Uchechukwu A, Felicia A, William Osebequin A. Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report. Int J Anesth Clin Med. 2023;11(2):115-118. doi: 10.11648/j.ijacm.20231102.20

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@article{10.11648/j.ijacm.20231102.20,
  author = {Agwu Nnanna Uchechukwu and Asudo Felicia and Adeyemi William Osebequin},
  title = {Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {11},
  number = {2},
  pages = {115-118},
  doi = {10.11648/j.ijacm.20231102.20},
  url = {https://doi.org/10.11648/j.ijacm.20231102.20},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20231102.20},
  abstract = {Spinal anesthesia is commonly used for various surgeries below the umbilicus including urological surgeries. Whereas many complications occur following administration of spinal anaesthesia such as hypotension, bradycardia, high spinal, post dural puncture headache, involuntary movement of the limbs is an extremely rare complication. It presents as a sudden shock-like involuntary muscle contractions affecting a single muscle or multiple muscle groups, which often resolves untreated. The characteristic of the presentation is different from those of typical myoclonus and the etiology is unclear. Here we presented a case of a 56-year-old known diabetic patient who developed jerky uncoordinated involuntary movements of the lower limbs with flexion at the hips after administration of spinal anaesthesia. These movements lasted 2-3 minutes, occurring without any form of stimulation in the limbs despite loss of sensation to the lower limbs. He was treated with iv ondansetron 8mg, iv hydrocortisone 200mg, iv chlorpheniramine 10mg. Symptoms improved after about 3 hours after induction of spinal anaesthesia with return sensory and purposeful motor function of the lower limbs. Involuntary movements of the lower limbs can occur unexpectedly following spinal anaesthesia in a diabetic patient. Anaesthestist should be mindful of this and be ready to manage the situation when it arises. 
},
 year = {2023}
}

Copy | Download

TY  - JOUR
T1  - Involuntary Movement of the Lower Limbs Following Subarachnoid Block in a Diabetic Patient: A Case Report
AU  - Agwu Nnanna Uchechukwu
AU  - Asudo Felicia
AU  - Adeyemi William Osebequin
Y1  - 2023/12/06
PY  - 2023
N1  - https://doi.org/10.11648/j.ijacm.20231102.20
DO  - 10.11648/j.ijacm.20231102.20
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 115
EP  - 118
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20231102.20
AB  - Spinal anesthesia is commonly used for various surgeries below the umbilicus including urological surgeries. Whereas many complications occur following administration of spinal anaesthesia such as hypotension, bradycardia, high spinal, post dural puncture headache, involuntary movement of the limbs is an extremely rare complication. It presents as a sudden shock-like involuntary muscle contractions affecting a single muscle or multiple muscle groups, which often resolves untreated. The characteristic of the presentation is different from those of typical myoclonus and the etiology is unclear. Here we presented a case of a 56-year-old known diabetic patient who developed jerky uncoordinated involuntary movements of the lower limbs with flexion at the hips after administration of spinal anaesthesia. These movements lasted 2-3 minutes, occurring without any form of stimulation in the limbs despite loss of sensation to the lower limbs. He was treated with iv ondansetron 8mg, iv hydrocortisone 200mg, iv chlorpheniramine 10mg. Symptoms improved after about 3 hours after induction of spinal anaesthesia with return sensory and purposeful motor function of the lower limbs. Involuntary movements of the lower limbs can occur unexpectedly following spinal anaesthesia in a diabetic patient. Anaesthestist should be mindful of this and be ready to manage the situation when it arises. 

VL  - 11
IS  - 2
ER  -

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