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Ischemic neuropathy presenting as prolonged epidural anesthesia
1Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Regional Anesthesia
|September 1, 1990
Summary
Neuropathy following surgery can mimic prolonged epidural anesthesia. Arterial thrombosis causing ischemia is a critical differential diagnosis for persistent neurologic deficits after epidural procedures.
Area of Science:
- Neurology
- Anesthesiology
- Vascular Surgery
Background:
- Prolonged neural blockade after epidural anesthesia can occur following major intraabdominal surgery.
- Commonly used agents include lidocaine and bupivacaine for anesthesia, with morphine for postoperative pain management.
Observation:
- A patient presented with neuropathy initially attributed to epidural anesthesia.
- Further investigation identified arterial thrombosis as the underlying cause of the neuropathy.
Findings:
- Ischemia is a recognized cause of neuropathy.
- Epidural narcotics can mask ischemic pain, leading to neurologic deficits resembling prolonged local anesthetic effects.
- Arterial thrombosis should be considered in the differential diagnosis of prolonged neurologic deficits post-epidural anesthesia.
Implications:
- Early recognition of ischemia as a cause of neurologic deficit is crucial.
- Clinical signs like asymmetrical or absent pulses warrant prompt investigation.
- Diagnostic angiography is recommended for suspected ischemia to facilitate timely surgical intervention and improve patient outcomes.