CO02 MANAGEMENT OF PERIPHERAL NEUROPATHY AFTER DELIVERY: ROLE AND LEADERSHIP OF THE ANESTHESIOLOGIST

Resumo

Category: Obstetric Anesthesia

Background: Postpartum nerve damage is an unusual complication of vaginal delivery mostly secondary to stretch or compression of the affected nerve due to delivery positioning. It is often underreported. We report a case of unilateral deep peroneal neuropathy in a patient under labor analgesia with epidural technique. Differential diagnosis with neuraxial complications is essential.  Anesthesiologists play a pivotal role on the evaluation, diagnosis and management of these patients.

Case Description: A nulliparous 22-year-old woman complained of weakness and numbness of the right inferior limb impairing gait, two days after vaginal delivery. Epidural technique was performed on first attempt and paresthesia were not reported. She was under labor epidural analgesia for 36 hours, with a programmed intermittent epidural bolus protocol using ropivacaine 0,1% with sufentanil 0,2 mcg/ml. She reported paresthesia in the right inferior limb and pain on the contralateral side during labor analgesia. Anesthesiologist evaluation described unilateral right-sided block and epidural catheter was withdrawn two centimeters, achieving a good pain control. Postpartum neurologic examination revealed a sensory loss of lateral leg and dorsum of the foot and weakness on dorsiflexion of the foot. Lumbar magnetic resonance imaging ruled out neurologic complications related to the epidural technique. Right deep peroneal neuropathy was inferred. Prolonged and/or excessive pressure over the fibular head during delivery positioning was formulated as etiology. The patient was referred to physiatry to start early rehabilitation program to improve function.

Conclusion: Understanding the risk factors and preventive measures, such as frequent repositioning and avoidance of excessive compression during delivery, for postpartum neuropathy are essential. Early recognition of neurological symptoms on the postpartum period is vital for an adequate and timely intervention. Excluding neuraxial complications is the first approach on these patients and therefore, anesthesiologists lead their early management. Anesthesiologists have a mainstay role on educating and engaging teams to adopt preventive measures and to create tools for early identification and referral of these patients. Multidisciplinary work with obstetrics, neurology and physiatry is essential to improve outcomes of postpartum neuropathy.