Question

A patient undergoes transurethral surgery of the under spinal anesthesia with lidocaine. Th e patient recovers well in the postoperative period, with return of sensory and motor responses, and is then discharged home 3 hours after his surgery. The next morning, he notices significant pain in his buttocks and bilateral legs 184 down to the knee. Which of the following conditions is he most likely to have?

A. Meralgia paresthetica
B. An intrathecal hematoma
C. Cauda equina syndrome
D. Transient neurologic symptoms
E. An abscess is developing near the subarachnoid space due to inadequate sterile precautions prior to block placement.

Answer 1

Transient neurologic symptoms are likely in the patient who underwent surgery with spinal anesthesia and now has pain in the buttocks and bilateral legs. TNS occurs due to the effect of local anesthetics like lidocaine on nerve signal transmission.

Step-by-step explanation:

The patient who underwent transurethral surgery with spinal anesthesia and is now experiencing significant pain in his buttocks and bilateral legs down to the knee is most likely suffering from Transient neurologic symptoms (TNS). This condition is characterized by moderate to severe pain radiating to the lower extremities after the resolution of spinal anesthesia. TNS typically appears within 24 hours after surgery and can last several days. Pain that occurs in the distribution of the sciatic nerve or its branches, which extend into the upper posterior leg, could be related to TNS. The local anesthetic, such as lidocaine, used in spinal anesthesia can cause numbness and pain by blocking voltage-gated sodium channels, which prevents the propagation of pain signals.