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REGIONAL ANESTHESIA

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

John Butterworth, MD^*, and Annette Douglas-Akinwande, MD

From the Departments of *Anesthesia and 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.