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complications of epidural
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complications of epidural - June 23, 2004 3:22:00 PM
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mgalkows
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Joined: June 22, 2004
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I have a patient with a c/c of LBP with numbness down 1 LE. Her problems began about 3 months ago after she had her 4th child. She had an epidural and was wondering how much that may have effected her current condition. I know that there are many risks associated with anesthesia in general. How common are these side effects such as LE numbness and backache? The backache might also be due to natural processes of birth in general. Any suggestions for treatment other than general strengthening and any idea how permanent these symptoms are?
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Re: complications of epidural - June 23, 2004 4:36:00 PM
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FLAOrthoPT
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Joined: May 8, 2004
From: West Palm Beach
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typically unilateral leg problems after pregancy should give you a big light bulb when treating. SI laxity is a typical problem from Relaxin (hormone) especially creating laxity in the Pelvic joints and then being stretched way out during birth, and staying relaxed for as long as 9 months after the last breast feeding. Well all this combined with the typical hold your child on one hip causes some pretty nasty SI problems. I'd try the Active SLR tests (Dianne Lee has some good info on this) and see if you can make a positive tests negative (painless or with less effort) by either manual external stabilization or internal stabilization. Anyway this may be more of an SI problem. However, true parasthesia or numbness can be from HNP caused during birth or even a real good sacral torsion can mimic some prblems by affecting the sacral plexus. I'd still say based on probability you're looking at a real severe SI laxity/instability, treat it as you would any other instability, education of activities to avoid making it worse, SI belt possibly, Internal pelvic floor/lumbo-sacral stab, rhythmic stab...etc, etc, etc...good luck
B.G. MPT, OCS
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Re: complications of epidural - June 23, 2004 9:36:00 PM
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Alex Brenner PT MPT OCS
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Joined: February 29, 2004
From: Kentucky
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Anne,
I seem to get this sort of history pretty often, after child birth. The patients seem to relate the epidural to their back pain because they usually remember that before the epidural they didnt have this back pain and then after this large needle was driven into their back they now have low back pain. Certainly the trauma from child birth can be a cause of the low back pain like mentioned by BG. With her current complaints of LE numbness it is imperative that you do a good neural screen to rule out a radiculopathy. Does she have any weakness within a certain myotome or loss of sensation over any dermatomes? How are her reflexes? If she has a true radiculpathy then this needs to be addressed first. I have not come across an SI joint causing a true radiculopathy in my practice. Rule out the radiculopathy first, then if you seen any SI dysfunction then you could certainly treat there. Good luck, keep us posted.
Army
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Alex Brenner, PT, MPT, OCS
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Re: complications of epidural - June 24, 2004 12:50:00 PM
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mgalkows
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Joined: June 22, 2004
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Thank you both for your reply. I will be sure to let you know what happens.
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Re: complications of epidural - June 24, 2004 4:06:00 PM
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Dr.Wagner
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The epidural didn't cause the radiculopathy...it is a fairly benign process and they go midline not laterally where the nerve roots are. An epidural are more benign than lumbar punctures, and that never causes radiculopathy (knock on wood). Gotta go with Army PT on this one!
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: complications of epidural - June 24, 2004 7:25:00 PM
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coloradojulie
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Joined: November 10, 2002
From: colorado usa
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What is the distribution of numbness? We have seen post partum clients X2 who have had femoral nerve palsies secondary to pushing aggressively for a long period of time. They both fully recovered, but had numbness and gross weakness in the nerve distribution.
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Re: complications of epidural - July 6, 2004 2:08:00 PM
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mgalkows
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Joined: June 22, 2004
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I thank you all for your feedback. I have, however, not seen this patient again since her initial evaluation. I appreciate all information you provided to me though as it will help me to better examine and treat future patients with similar problems. Thanks again.
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