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Peripheral neuropathy masquerading as an epidural complication.

D L Sommerfield¹, P McDonagh, A M Heffernan

¹Department of Anaesthesia, Critical Care and Pain Medicine, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland. dsommerfield@hotmail.com

Irish Journal of Medical Science

|April 23, 2010

Summary

A patient developed foot drop after knee replacement surgery; investigations revealed the cause was an intraoperative tourniquet, not the epidural anaesthesia. This highlights the importance of accurate diagnosis for nerve injuries following orthopedic procedures.

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Area of Science:

Orthopedic Surgery
Pain Management
Neurology

Background:

Epidural anaesthesia is commonly used for postoperative pain control after total knee replacement.
While generally safe, epidural anaesthesia carries a small risk of neurological complications.

Observation:

A 30-year-old woman with rheumatoid arthritis developed foot drop after a total knee replacement managed with epidural anaesthesia.
Investigations, including MRI and nerve conduction studies, ruled out epidural-related nerve damage.

Findings:

The patient's neurological deficit was attributed to an intraoperative tourniquet used during the knee replacement.
This case underscores the potential for misattributing nerve injuries to epidural analgesia.

Implications:

Accurate diagnosis of neurological deficits post-surgery is crucial.
The study prompts a review of epidural use and nerve injury management protocols in knee replacement patients.
It emphasizes that surgical factors, like tourniquet use, are more likely causes of neurological complications than epidural analgesia.