Managers of 23 years old, identical, weighing 66 kg and 162 cm tall, who, in the 35 week of a twin pregnancy in a situation of pain, request epidural analgesia by transverse delivery.
As PA: NRAMC, no medical diseases of interest, right facial paralysis.
We reviewed the clinical and analytical history of the pregnant woman and after checking that there was no contraindication for this type of analgesia, and obtaining informed consent from the patient underwent epidural anesthesia.
The degree of cervical dilation of the patient was a Bishop of 6.
A single puncture with 18G Tuohy needle (BraunR) at L4-L5 level was performed with the patient in sitting position and without turning the needle an epidural catheter of 20G was placed after identification of the epidural space.
A test dose of 3 ml bupivacaine 0.5% with 1/200,000 was administered without incidents.
Subsequently, an initial bolus dose of 0.2% ropivacaine 8 ml and 50 μg fentanyl was administered.
An infusion of 0.125% ropivacaine and 1.2 μg/ml fentanyl at 10 mg/h plus PCA with 10 mg boluses was also initiated, with a 30-min block interval, and the patient underwent a complete dilation test four hours after delivery.
A booster dose was administered epidurally with 10 ml of 0.5% ropivacaine and 2 μg/ml fentanyl.
The spontaneous Apgar score of both twins was observed; both neonates presented one minute and five minutes after nine, with a pH of 7.36, performing a Kristocratic without observing complications second twin.
After 15 minutes, the patient began to present dysesthesia in the right hemisphere and right upper limb, not associated with hemodynamic instability.
Then, when the patient was already in the recovery area, the patient reported motor and sensory block of the lower limbs associated with loss of strength of the right upper limb and diagnosed with clubfoot syndrome, miosis with light redness.
Two hours later, the patient had spontaneously recovered the strength of the hand, as well as sensory and motor block of the lower limbs, although ptosis 1 hbral persisted and myosis disappeared.
