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Caesarean Delivery Complicated by Unintentional Subdural Block and Conversion Disorder

DOI: 10.1155/2013/751648

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Combined spinal epidural (CSE) can provide excellent labor analgesia. Subdural block is also a potential but rare complication of attempted epidural placement during a CSE procedure, which may present as a block that is usually patchy in nature, with a component of sensory and/or motor deficit and a variable duration of action. In addition, a conversion disorder or a functional neurological disorder has been described with epidural and spinal anesthesia in obstetric patients. In this clinical report, we describe a 33-year-old G4P3 at 40 weeks gestation that received an unintentional subdural block as part of her labor analgesia and after an uneventful caesarean delivery presented with a conversion disorder. The rarity of the association between a subdural block and a conversion disorder complicated by the fact that the neurological deficit produced by the subdural block and that produced by a conversion disorder are similar in distribution made the clinical presentation and diagnosis a challenge for the obstetric anesthesia team. A functional neurological disorder of this nature complicating a subdural block in an obstetric anesthesia clinical practice has not been described so far. 1. Introduction Combined spinal epidural (CSE) can provide excellent labor analgesia. Complications of this procedure are uncommon, but they may include bleeding, infection, failed block, and nerve root injury [1]. Subdural block is also a potential but rare complication of attempted epidural placement during a CSE procedure, which may present as a block that is usually patchy in nature, with a component of sensory and/or motor deficit and a variable duration of action. In addition, the literature is rampant with reports of a conversion disorder or a functional neurological disorder in conjunction with epidural and spinal anesthesia in obstetric patients [2, 3]. However, this type of conversion disorder complicating a subdural block has not been described so far. In this report, we describe a patient who had a conversion disorder after undergoing a caesarean delivery following an unintentional subdural injection. The rarity of the association between a subdural block and a conversion disorder complicated by the fact that the neurological deficit produced by the subdural block and that produced by a conversion disorder are similar in distribution made the clinical presentation and diagnosis a challenge for the obstetric anesthesia team. 2. Case Description A 33-year-old G4P3 at 40 weeks gestation presented to the labor and delivery unit in active labor. Her past medical

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