Postoperative paraplegia associated with epidural narcotic administration

Area of Science:

• Anesthesiology
• Neurosurgery
• Oncology

Background:

• Postoperative pain management is crucial, especially after major thoracic surgery like lobectomy.
• Epidural analgesia is a common method for managing severe postoperative pain.
• Pulmonary carcinoma patients often require complex surgical interventions and pain control strategies.

Observation:

• A patient undergoing right upper lobectomy for pulmonary carcinoma developed paraplegia postoperatively.
• Neurological status declined progressively following each epidural buprenorphine injection.
• Surgical exploration revealed an expanded oxidized cellulose (Oxycel) pledget within the epidural space.

Findings:

• The neurological dysfunction was directly attributed to the migrated oxidized cellulose pledget.
• The oxidized cellulose, used for surgical hemostasis, expanded within the epidural space.
• Expansion was exacerbated by the epidural narcotic solution and blood, leading to spinal cord compression.

Implications:

• Oxidized cellulose (Oxycel) poses a risk of delayed neurological complications when used in proximity to the epidural space.
• Careful placement and consideration of material migration are essential during spinal surgeries.
• This case highlights the importance of thorough diagnostic evaluation for unexplained neurological deficits following epidural procedures.