Numbness above nipple and on one side of abdomen

[polka-dot, RN]

Our study guide gives a scenario of a pt who is post-op for an ileoconduit. He has epidural bupivicaine, diabetes, a traumatic left arm amputation with phantom pain, chronic low back pain and is on drugs that cause peripheral neuropathy when taken in combination. The question is what do you do if your pt has numbness 3 inches above the nipple line, or if he has numbness on one side of his abdomen only. We've looked all over and the only thing we can think of is is that the abdomen is referred numbness from the epidural...and possible neuropathy for the chest. The only glitch is, the drugs cause peripheral neuropathy, not necessarily neuropathy in the chest.

Any clues would be greatly appreciated! If you need more information, let me know and I'll provide it...the case study itself is quite long so I just listed here what we suspect is most relevant.

Thank you!

[Daytonite, BSN, RN]

Complications of epidural anesthesia are:

• hypotension
  
• rash around the epidural injection site
  
• nausea and vomiting from the opiates administered
  
• pruritis of the face and neck caused by some epidural narcotics
  
• respiratory depression up to 24 hours after the epidural
  
• cerebrospinal fluid leakage and spinal headache from accidental dural puncture
  
• sensory problems in the lower extremities
  

This patient is having numbness 3 inches above the nipple line and numbness on one side of his abdomen only. I have had a number of abdominal surgeries and neuropathic pain from a ruptured spinal disc and then a pinched spinal nerve. When the surgeons cut into skin and tissues of the abdomen the patient can end up with numbness of the skin over the abdominal area where there was surgery. It's because the superficial nerves in the skin were severed. The surgeons can't see them when they are making the incisions. If this abdominal numbness is on the same side that the ileoconduit was done, I wouldn't be surprised. There is a lot of work and manipulation of the tissues when an ileoconduit is done. The numbness 3 inches above the nipple line sounds like another damaged nerve problem high up in the chest area. That's too high for epidural anesthesia to have affected the patient. Was there a previous back or chest injury when the left arm amputation occurred?

[polka-dot, RN]

Awesome Daytonite...thanks so much! I don't know much about the arm amputation except that it was traumatic. That leads me to believe that it wasn't surgical, so nerve damage sounds like a definite possibility.

Someone I talked to today mentioned that if he were lying on his back the epidural anesthesia might "leak" upward...is that possible? Would you have to worry at all about the diaphragm getting involved with an epidural?

[Daytonite, BSN, RN]

Not sure. I would ask the nurses on the OB forum if they keep the mothers who have had epidurals flat. I had 6 epidurals for neuropathic pain, but steroids were injected. I was kept flat after each of them. I don't think the fluid migrates much beyond the epidural area.