Aphonia and quadriplegia---a rare complication following epidural labor analgesia

We report an obstetric patient who developed unusual neurological complications after an epidural injection of a local anesthetic and a narcotic in a seemingly faultless manner. Ten minutes after receiving a loading dose, the patient developed aphonia, quadriplegia, and facial palsy while retaining normal consciousness and stable hemodynamics. The episode spontaneously resolved 40 minutes later. We wish to draw attention to anesthesiologists of the possibility that even in the presence of a negative aspiration test or without noticeable dural puncture, the injected drugs may enter the intrathecal or subdural space instead of pooling entirely in the epidural compartment. Once an unexpected high block and unusual symptoms or signs are noted, a prompt differential diagnosis must be made and treatment initiated as soon as possible.