Conus Medullaris/Cauda Equina Syndrome Following a Repeated Bupivacaine 1% Spinal Anesthesia- Analysis of a Case with Review of the Literature

In the morning a healthy 40 years old female had a successful spinal anesthetic with bupivacaine 1% 10 mg for hemorrhoidectomy followed by a second injection at midnight for severe pain. The second traumatic injection caused a conus medullaris/cauda equina lesion discovered by MRI 45 days later. The contribution of hyperbaric bupivacaine dosage and pencil point needle is discussed.