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Published on: October 14, 2022
Lower extremity paralysis after thoracotomy or thoracic epidural: image first, ask questions later
John Butterworth1, Annette Douglas-Akinwande
1Department of Anesthesia, Indiana University School of Medicine, Indianapolis, Indiana, USA. jfbutter@iupui.edu
Background:
When an epidural catheter is present, new motor deficits will often be attributed to a local anesthetic effect, potentially delaying imaging studies, or to an epidural hematoma, ignoring other mechanisms of spinal cord injury.
Methods:
A 69-yr-old female patient undergoing thoracotomy received a preoperative thoracic epidural for postoperative analgesia.
Results:
Intraoperatively, there was bleeding near the costovertebral junction. Hemorrhage was controlled with cellulose gauze and bone wax. Paralysis developed postoperatively and was initially misdiagnosed as a local anesthetic effect when, in fact, it was caused by an extradural deposit of cellulose gauze and bone wax.
Conclusions:
We emphasize the need for prompt, definitive imaging when new lower extremity weakness develops after thoracotomy or thoracic epidural analgesia.
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