Thoracic epidural block performed safely in anesthetized patients. A study of a series of cases

The development of paraplegia following the insertion of epidural catheter in anesthetized patients raised questions by some authors about the procedure, even without the confirmation that the lesion occurred because the patient was anesthetized. For this reason, we designed this study, with the objective to evaluate the frequency of neurological complications and development of sequelae after thoracic epidural block in patients under general anesthesia.

Patients undergoing thoracic surgeries from 02/16/2004 to 05/30/2006 participated in the study. After monitoring vital signs and the installation of general anesthesia, patients were placed in lateral decubitus for simple or continuous thoracic epidural block. Intercurrences, complications, and technical difficulties were recorded on a special form. Patients were followed postoperatively to detect the development of any signs and symptoms of neurological dysfunction.

One hundred and thirteen patients were evaluated and the thoracic epidural catheter was placed in 108 patients. The puncture was considered traumatic, i.e., bleeding at the puncture site and multiple punctures, in 45 patients. Accidental perforation of the dura-mater occurred in two patients. In the immediate postoperative period, a patient complained of tingling in the lower limbs, another patient developed numbness in an upper limb, which resolved after the catheter was removed. Both patients had a single puncture. The other patients did not develop any signs or symptoms of neurologic changes.

The cases studied here did not develop any neurologic complications. When performed judiciously and with specific care, thoracic epidural block can be safely done in the anesthetized patient.