A 47-year-old woman about to undergo a dilatation and curettage for the evaluation of excessive menstrual bleeding is vehemently opposed to general anesthesia. She's suffered from excessive post-anesthesia nausea and vomiting - once so severe she spent a night in the hospital.

The anesthesiologist explains that he could use a general anesthetic technique that would minimize the chances of PONV, but the patient says no. The anesthesiologist asks the gynecologist about combining a para-cervical block with sedation, but the surgeon has little experience with para-cervical blocks and is unwilling to perform one. The anesthesiologist elects to use spinal anesthesia. He explains the anesthetic to the patient and obtains her permission to proceed.

The anesthesiologist preps the patient's back with betadine. He chooses Xylocaine (lidocaine), a fast- and short-acting spinal anesthetic. He places the patient in a sitting position and palpates the intravertebral space. He easily enters the spinal canal on the first attempt with a 25-gauge spinal needle.

He slowly injects 1.5cc of spinal Xylocaine and places the patient in the lithotomy position within a few minutes. After testing for an adequate level of anesthesia, the gynecologist performs the 15-minute dilatation and curettage. After 90 minutes in PACU, the patient is discharged in good condition with no note of residual neurological deficits.

The following day, the patient tells the nurse making post-op calls that she's experiencing pain, numbness and tingling in her lower right leg. The nurse tells the patient that the symptoms would pass and asks her to call if they persist. They do.

The patient calls the next day and tells the nurse who answers that her symptoms, while better, are still bothersome. The nurse refers the call to the anesthesiologist, who's concerned enough to refer the patient to a neurologist for evaluation.

The neurologist performs an extensive battery of tests, including an MRI of the lumbar spine and an EMG of the lower extremities. The final diagnosis: a lumbar radiculopathy involving the L-5 nerve root on the right side. While the etiology is unclear, the neurologist believes that the findings are consistent with, although not pathognomic of, Xylocaine-induced neurotoxicity.

The patient, who continued to complain of numbness, pain and tingling of her leg, brings suit against the anesthesiologist, claiming that he negligently administered the spinal anesthetic. Also, the patient's husband files a derivative suit claiming damages for loss of his wife's companionship and services. In his defense, the anesthesiologist answers that the spinal had been routine, he'd obtained consent and that he'd used an FDA-approved agent for the anesthetic.

Before you consider how the jury handled this claim of negligence, keep in mind that some researchers believe that spinal Xylocaine can cause permanent neurological damage and that, given the availability of alternative agents, the use of Xylocaine should be abandoned. If used at all, they say, spinal Xylocaine should be diluted and injected forcefully in order to prevent the pooling of concentrated Xylocaine against the nerve roots.