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Anesth Analg 2007;104:201-203
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000250362.34569.20

REGIONAL ANESTHESIA

Lower Extremity Paralysis After Thoracotomy or Thoracic Epidural: Image First, Ask Questions Later

John Butterworth, MD*, and Annette Douglas-Akinwande, MD{dagger}

From the Departments of *Anesthesia and {dagger}Radiology, Indiana University School of Medicine, Indianapolis, Indiana.

Address correspondence and reprint requests to J. Butterworth, MD, Department of Anesthesia, 1120 South Dr., FH 204, Indianapolis, IN. Address e-mail to jfbutter{at}iupui.edu.

BACKGROUND: When an epidural catheter is present, new motor deficits will often be attributed to a local anesthetic effect, potentially delaying imaging studies, or to an epidural hematoma, ignoring other mechanisms of spinal cord injury.

METHODS: A 69-yr-old female patient undergoing thoracotomy received a preoperative thoracic epidural for postoperative analgesia.

RESULTS: Intraoperatively, there was bleeding near the costovertebral junction. Hemorrhage was controlled with cellulose gauze and bone wax. Paralysis developed postoperatively and was initially misdiagnosed as a local anesthetic effect when, in fact, it was caused by an extradural deposit of cellulose gauze and bone wax.

CONCLUSIONS: We emphasize the need for prompt, definitive imaging when new lower extremity weakness develops after thoracotomy or thoracic epidural analgesia.




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44597 - POST-OPERATIVE ACUTE ANTERIOR SPINAL ARTERY SYNDROME AFTER RIGHT UPPER LOBECTOMY COMPLICATED BY PULMONARY ARTERY INJURY
Can J Anesth, August 1, 2007; 54(suppl_1): 44597 - 44597.
[Abstract] [Full Text] [PDF]


Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2007 by the International Anesthesia Research Society.