Transient Bulbar-Like Neuromuscular Manifestations Following Spinal Anaesthesia with Hyperbaric Bupivacaine: A Case Report

Spinal anaesthesia using hyperbaric bupivacaine is widely regarded as a safe and reliable technique when administered within recommended dose ranges. While complications such as high spinal anaesthesia and local anaesthetic systemic toxicity are well described, atypical neurological manifestations without associated hemodynamic instability are rarely reported. We describe a case of a young adult male who developed transient bulbar-like neuromuscular manifestations following spinal anaesthesia with a standard dose of hyperbaric bupivacaine. After a rapid onset of complete lower limb motor block and mid-thoracic sensory blockade, the patient exhibited subtle lower limb fasciculations and subsequently developed tongue fasciculations in the absence of hypotension, bradycardia, respiratory compromise, or altered consciousness. The symptoms persisted into the early postoperative period and resolved spontaneously without intervention or residual neurological deficit. This case highlights an unusual presentation suggestive of abortive neurotoxicity following intrathecal bupivacaine administration and underscores the importance of recognising atypical, self-limiting neurological events during spinal anaesthesia.