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Possible Transient Anterior Spinal Artery Syndrome After a Celiac Plexus Neurolytic Block

Celiac plexus blocks have been utilized to treat chronic abdominal pain of various etiologies that are refractory to medication management. This procedure is considered relatively safe; however, one rare complication is anterior spinal artery syndrome, which can result in temporary or permanent para...

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Autores principales: West, Tyler, Pogu, Summer, Wanderman, Robalee, Olatoye, Oludare
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10506893/
https://www.ncbi.nlm.nih.gov/pubmed/37731414
http://dx.doi.org/10.7759/cureus.43771
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author West, Tyler
Pogu, Summer
Wanderman, Robalee
Olatoye, Oludare
author_facet West, Tyler
Pogu, Summer
Wanderman, Robalee
Olatoye, Oludare
author_sort West, Tyler
collection PubMed
description Celiac plexus blocks have been utilized to treat chronic abdominal pain of various etiologies that are refractory to medication management. This procedure is considered relatively safe; however, one rare complication is anterior spinal artery syndrome, which can result in temporary or permanent paralysis of the lower extremities. A 67-year-old male with a history of metastatic esophageal adenocarcinoma and chronic pain refractory to high doses of opioids presented for a celiac plexus neurolytic block. The block was performed successfully with a test block containing 2% lidocaine and 0.5% bupivacaine, after which neurolysis with alcohol was completed. The patient had a syncopal episode in the post-anesthesia care unit (PACU), which resolved with fluid resuscitation without requiring advanced cardiovascular life support (ACLS). He was then discharged. On the evening of discharge, the patient had progressive lower extremity weakness to the point where he was unable to walk even with significant assistance from a family member. He went to the emergency department where a complete spine MRI was done which did not show any spinal cord defect. His physical exam showed preserved proprioception and vibration sensation with upper motor neuron exam signs. The remainder of his sensory exam was inconsistent with both reported intact sensation to pinprick and temperature with intermittently reported hyperalgesia in his lower extremities. Over the next day of admission, his weakness slowly improved. Unfortunately, the patient developed a bowel perforation during hospitalization that was non-operable, and he passed away on hospital day five. This patient likely had anterior spinal artery vasospasm causing temporary lower extremity weakness. Given his overall debility, his physical exam was difficult, although he had intact proprioception and vibration sensation with upper motor neuron exam findings suggestive of an anterior cord process. Vasospasm could be secondary to needle placement near the artery of Adamkiewicz, alcohol, or epinephrine. This case emphasizes the importance of recognizing anterior spinal artery syndrome despite its rarity in patients undergoing celiac plexus neurolysis. Regardless of the rarity of various complications, it is imperative that physicians discuss potential devastating complications of procedures with patients to allow for individualized decision-making. Additionally, there should be a low threshold for overnight admission after celiac plexus neurolytic blocks in patients with severe underlying systemic disease processes.
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spelling pubmed-105068932023-09-20 Possible Transient Anterior Spinal Artery Syndrome After a Celiac Plexus Neurolytic Block West, Tyler Pogu, Summer Wanderman, Robalee Olatoye, Oludare Cureus Pain Management Celiac plexus blocks have been utilized to treat chronic abdominal pain of various etiologies that are refractory to medication management. This procedure is considered relatively safe; however, one rare complication is anterior spinal artery syndrome, which can result in temporary or permanent paralysis of the lower extremities. A 67-year-old male with a history of metastatic esophageal adenocarcinoma and chronic pain refractory to high doses of opioids presented for a celiac plexus neurolytic block. The block was performed successfully with a test block containing 2% lidocaine and 0.5% bupivacaine, after which neurolysis with alcohol was completed. The patient had a syncopal episode in the post-anesthesia care unit (PACU), which resolved with fluid resuscitation without requiring advanced cardiovascular life support (ACLS). He was then discharged. On the evening of discharge, the patient had progressive lower extremity weakness to the point where he was unable to walk even with significant assistance from a family member. He went to the emergency department where a complete spine MRI was done which did not show any spinal cord defect. His physical exam showed preserved proprioception and vibration sensation with upper motor neuron exam signs. The remainder of his sensory exam was inconsistent with both reported intact sensation to pinprick and temperature with intermittently reported hyperalgesia in his lower extremities. Over the next day of admission, his weakness slowly improved. Unfortunately, the patient developed a bowel perforation during hospitalization that was non-operable, and he passed away on hospital day five. This patient likely had anterior spinal artery vasospasm causing temporary lower extremity weakness. Given his overall debility, his physical exam was difficult, although he had intact proprioception and vibration sensation with upper motor neuron exam findings suggestive of an anterior cord process. Vasospasm could be secondary to needle placement near the artery of Adamkiewicz, alcohol, or epinephrine. This case emphasizes the importance of recognizing anterior spinal artery syndrome despite its rarity in patients undergoing celiac plexus neurolysis. Regardless of the rarity of various complications, it is imperative that physicians discuss potential devastating complications of procedures with patients to allow for individualized decision-making. Additionally, there should be a low threshold for overnight admission after celiac plexus neurolytic blocks in patients with severe underlying systemic disease processes. Cureus 2023-08-19 /pmc/articles/PMC10506893/ /pubmed/37731414 http://dx.doi.org/10.7759/cureus.43771 Text en Copyright © 2023, West et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Pain Management
West, Tyler
Pogu, Summer
Wanderman, Robalee
Olatoye, Oludare
Possible Transient Anterior Spinal Artery Syndrome After a Celiac Plexus Neurolytic Block
title Possible Transient Anterior Spinal Artery Syndrome After a Celiac Plexus Neurolytic Block
title_full Possible Transient Anterior Spinal Artery Syndrome After a Celiac Plexus Neurolytic Block
title_fullStr Possible Transient Anterior Spinal Artery Syndrome After a Celiac Plexus Neurolytic Block
title_full_unstemmed Possible Transient Anterior Spinal Artery Syndrome After a Celiac Plexus Neurolytic Block
title_short Possible Transient Anterior Spinal Artery Syndrome After a Celiac Plexus Neurolytic Block
title_sort possible transient anterior spinal artery syndrome after a celiac plexus neurolytic block
topic Pain Management
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10506893/
https://www.ncbi.nlm.nih.gov/pubmed/37731414
http://dx.doi.org/10.7759/cureus.43771
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