Epidural abscess after patient-controlled epidural analgesia. Case report

Epidural analgesia is often used to control postoperative pain or to manage chronic pain in oncologic patients. However, it is not free from complications. This case reports a young healthy female patient submitted to epidural analgesia in patient-controlled infusion pump, which developed epidural abscess requiring surgical decompression.

Female patient, 24 years of age, 56 kg, 1.65 m, physical status ASA I, with history of low back pain and difficulty to bend left thigh, submitted to posterior hip muscles surgical release. Three days after hospital discharge, patient returned referring pain at surgical incision site and during physical therapy. Patient was admitted to hospital and patient-controlled epidural analgesia (PCA) was prescribed to allow physical therapy. Patient was sedated in the operating room with intravenous midazolam (2.5 mg) and fentanyl (25 microg), skin was disinfected and epidural puncture was performed at L3-L4 interspace. After the test dose, 0.75% ropivacaine (75 mg) and fentanyl (100 microg) were injected and an epidural catheter was inserted in the cephalad direction without intercurrences. PCA pump containing 0.9% saline solution (85 ml), 0.5% bupivacaine (25 mg) and fentanyl (500 microg) was installed, with constant 4 ml h(-1) flow and 2 ml bolus at 20-minute intervals. In the 3rd day, patient referred discomfort at catheter insertion site and catheter was removed. There was mild local hyperemia. Twenty-two days later patient returned to hospital with severe lumbosacral movement-limiting pain irradiating to lower limbs. There were no neurological deficits or flogistic signs at puncture site or surgical wound. The hypothesis was epidural abscess confirmed by MRI at L3-L4 (2 x 3 cm). After laminectomy, material culture has revealed staphylococcus aureus. Patient evolved well without neurological sequelae.

Epidural analgesia often used to control postoperative or chronic pain, although very effective, is not free from severe, although rare complications, such as epidural abscess.