Case Report: Opioid-Induced Movement Disorder in the Immediate Postoperative/partum Period

Background Opioid-induced movement disorders (OIMD) are a rare cause of dystonia in the perioperative setting. Here we present a case of OIMD, responsive to naloxone, immediately after cesarean delivery. Objective(s): The purpose of this report is to describe the critical parts of our workup that helped determine the etiology of this patient’s new movement disorder. Study Design Case report of a single patient seen at Tripler Army Medical Center. Case Summary (Results): A 34-year-old G2P0 at 37+6 days’ gestation with preeclampsia with severe features was delivered of a live female, vigorous infant via cesarean section due to arrest of decent. The patient’s pain was managed with fentanyl-bupivacaine via epidural catheter, IV fentanyl, and IV morphine. At the time of skin closure, the patient developed episodic, dystonic neck and upper extremity movements, and confusion. She remained hemodynamically stable and responsive. The patient’s symptoms resolved with IV Naloxone, with no recurrence of these episodes in the post-partum period. Conclusion(s): To the best of our knowledge, this is the first case of OIMD in a peripartum patient. The unique physiologic conditions of pregnancy can contribute to development of movement disorders. OIMDs, although rare, are an important etiology to consider in post-operative or post-analgesic dystonia. Naloxone is the treatment of choice in OIMDs.