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Paraplegia following epidural analgesia: A potentially avoidable cause?
Jeson R Doctor1, Priya Ranganathan1, Jigeeshu V Divatia1
1Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India.
Saudi Journal of Anaesthesia
|May 21, 2014
Summary
Neurological deficit from epidural anesthesia is rare but serious. This case highlights vertebral metastases causing epidural hematoma, emphasizing careful pre-operative assessment and monitoring for central neuraxial blockade.
Area of Science:
- Anesthesiology
- Neurology
- Oncology
Background:
- Epidural anesthesia complications, though uncommon, can be catastrophic.
- Epidural hematomas and abscesses are primary causes of neurological deficit post-epidural anesthesia.
Observation:
- A patient with renal cell carcinoma and lumbar vertebral metastasis developed paraplegia post-thoracic epidural anesthesia.
- The patient underwent nephrectomy, with anesthesia administered via the thoracic epidural route.
Findings:
- Histo-pathological examination revealed previously undiagnosed thoracic vertebral metastases.
- These metastases were the cause of a thoracic epidural hematoma, leading to paraplegia.
Implications:
- Delayed symptom reporting by the patient may have worsened the outcome.
- Preventing such complications requires thorough pre-operative evaluation, considering alternative analgesia, comprehensive patient counseling, and vigilant monitoring during central neuraxial blockade.