Monoplegia following obstetric epidural anaesthesia

We describe a case of transitory monoplegia following obstetric epidural anaesthesia which we believe to be either due to direct trauma to the nerve roots or radicular artery spasm resulting in spinal cord ischaemia both secondary to the epidural catheter. An obstetric epidural was performed on a 34-year-old lady with no significant past medical history. Transient radicular pain down her left leg was experienced during the insertion of the catheter. She had unilateral block on her left side which could not be rectified despite injecting local anaesthetics in the right lateral position, resiting the epidural catheter, and administering a total dose of 6 ml of 1.5% plain lignocaine and 19 ml of 0.25% plain bupivacaine. There was no hypotension, and no vasoconstrictor was used epidurally. She still had left-sided numbness and weakness 9 hours after removal of the catheter, but without urinary or bowel dysfunction. A magnetic resonance imaging scan excluded any space occupying lesion. She was managed conservatively and had complete recovery 35 hours after the last dose of local anaesthetics.