Recurrent Vasovagal Syncope Triggered by Procedural Pain and Post-operative Analgesia during Spinal Anesthesia for High Tibial Osteotomy: A Case Report

Introduction: Vasovagal syncope is a common reflex-mediated condition characterized by transient loss of consciousness due to autonomic imbalance resulting in hypotension and bradycardia. Although it is frequently encountered in response to pain or emotional stress, its occurrence during the perioperative period under regional anesthesia is relatively uncommon but potentially alarming. Case Report: We report the case of a 39-year-old female with no significant comorbidities who presented with pain, swelling, instability, and locking of the right knee for 1.5 months. Magnetic resonance imaging revealed a posterior root tear of the medial meniscus, and she was scheduled for high tibial osteotomy with medial meniscus repair under neuraxial anesthesia. During preparation for combined spinal-epidural anesthesia, the patient developed a vasovagal syncope episode following local anesthetic infiltration. She was managed promptly with atropine, ephedrine, and supportive measures. After stabilization, spinal anesthesia with 0.5% hyperbaric bupivacaine and clonidine was administered successfully. The surgery lasted 3.5 h, and remained hemodynamically stable intraoperatively. However, in the post-operative recovery room, the patient developed another vasovagal episode associated with severe pain, which responded to intravenous atropine. She recovered without further complications. Conclusion: This case highlights the possibility of recurrent vasovagal syncope during the perioperative period triggered by pain and procedural stimuli. Awareness, prompt recognition, and early management are crucial to prevent serious complications.