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Anesthesia

Shoulder & Neck Pain after C-Section

09/21/2006

Question:

Regarding the question relating to "Neck pain after C-section" dated 06/02/2006 01:20PM. Is there any way for you to contact this person for the outcome of her neck pain post C-Section? We are most interested.

My daughter had an epidural/spinal anesthetic for her C-Section 12 days ago. Immediately when positioned on the surgery table she noted right shoulder pain that increased to severe neck and bilateral shoulder pain by the 2nd post op day. This required 2 Percocet every 4 hours to merely dull the pain. This treatment continues today to manage the pain to this same `dull` level.

Since her 3rd post op day the right shoulder has been free of pain but her left shoulder, neck and around her shoulder blade (medial edge and under) continue to be extremely painful (a 10 on the 1-10 pain scale) without the 2 Percodet every 4-5 hours. She cannot tolerate even the lightest tough to her shoulder without the analgesics in effect. She also found that Rx Motrin was not effective.

The pain is now progressing to a radiation of aching down her left arm and hand.

She is normally very sensitive to any medication. Before the C-Section, she required only 1 tablet of Tylenol or Advil, occasionally, to manage other types of pain.

She has been evaluated by anesthesia,who prescribed the Perocet and Motrin, without a diagnosis; her OB Dr,without a diagnosis, who referred her to an Orthopedic MD who ruled out a rotator cuff problem, who prescribed Physical Therapy also without a diagnosis. She will start Physical Therapy next week. Chiropratic and accupuncture have provided a bit of short term relief but not lasting.

The extensive medication is a concern for this breast feeding mother as is her ability to care for her baby while severe pain or in a medicated state.

Any insite and suggestions are appreciated as well as the outcome information from the lady in the initial question. Thank You.

Answer:

NetWellness is founded on the principle of complete anonymity for those submitting questions. We do not know the identity of those people who submit questions and, of course, even if we did we could not tell you or anyone else.

You daughter's history is a complicated and puzzling one. It seems very unlikely that her epidural or spinal anesthetic had anything to do with the pain she is now experiencing. I certainly have not encountered or read about anything resembling this in relation to a regional anesthetic. If there were a direct nerve injury from the anesthetic we would expect a history of pain at the time of insertion of the needle, and we would expect symptoms to be limited to the lower part of the body. Headache is a well-known complication of epidural or spinal anesthetic (about 1 in 100-200 cases) but you do not mention headache as part of the problem.

Your daughter needs a proper evaluation by an expert clinician - perhaps a neurologist - to establish a diagnosis. The clinician will need to know a lot more than what you've told me, including whether there was any previous history of pain, of muscular or skeletal problems, vascular disorders, neuropathy, trauma, etc. A careful physical examination is also needed. My best guess is that there may be something going on in the cervical spine, such as a herniated disc.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University