Expert: Dr Ian Jackson - please note UK based - 8/31/2007

Question
QUESTION: Hello.  I really hope you can help me.
I had a spinal for my c-section on Friday 17 August.  On Sunday 19 August my right foot felt slightly numb.  Then on the following Tuesday, both feet and up to my knees in both legs have been tingling, feel numb, feel asleep.  They feel as if the spinal is starting to work again!  Im also very itchy and have been since after the operation.  (12 days now).  I wondered if you could possibly tell me what this could be.  Many thanks.

ANSWER: Hi Elizabeth
I'm guessing that this was done in the UK. The most likely agents used for this would be a combination of the local anaesthetic bupivacaine and a longer acting opioid drug called diamorphine (but some units use fentanyl).
If this is the case then the itching can be linked to the effect of the diamorphine though the effect doesn't normally last this long. However it is possible.
Now the numb feeling and tingling in your legs could be something called Transient Neurological Syndrome. This occurs more frequently in patients who have received lidocaine as the local anaesthetic but has been noted in patients having bupivacaine. This usually resolves over a week or two.
However if you continue to have problems or have any actual weakness in your legs you should report the problem to your obstetric and anaesthetic team immediately. It is unlikely to be a problem but if you have continuing or worsening symptoms then I am sure they would want to see you.
I hope these problems are not interfering with your ability to look after your baby.
Kind regards
Dr Ian Jackson


---------- FOLLOW-UP ----------

QUESTION: Hello.  Thank you so much for replying so quickly!
I have been to 3 general doctors and spoken to my OB, who all say my symptoms dont sound like anything serious and it could take up to 6 weeks to recover from a c-section.  The pain today seems to be more in my knees, both knees.  Why do my symptoms happen exactly in the same places in both legs or feet?  WOuld you know of a Doctor who I could go and see privately to get this sorted out.  I feel very let down by the doctors I have seem already.  I live in Maidstone, Kent.  WOuld it be very expensive?  Many thanks again.

Answer
Hi Elizabeth
I am really sorry that your symptoms are causing you distress. However I do not believe that anyone can provide you with a magic cure and so would urge you not to try and see someone privately.
As I mentioned I believe this may well be something called TNS and it will settle down. My only reason to mention seeing someone if it got worse was the very very remote possibility of you having developed some other problem within your spine.
No one fully understands why this happens to a small number of people but it does, we also do not understand the symptoms that people experience (these can occur in both limbs though this is even more unusual). People will give lots of possible causes but the reality is we don't know. It is also true that it does happen to only a few people - if it was common then everyone would know about it and we as anaesthetists would be very resistant to using the technique.
Please feel free to keep in contact - though I'm sure your local anaesthetic department would also provide support.
Dr Ian Jackson