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REGIONAL ANESTHESIA

Paraplegia After Delayed Detection of Inadvertent Spinal Cord Injury During Thoracic Epidural Catheterization in an Anesthetized Elderly Patient

Ming-Chang Kao, MD^*, Shen-Kou Tsai, MD PhD^*,, Mei-Yung Tsou, MD PhD^*,, Hsien-Kuang Lee, MD^*, Wan-Yuo Guo, MD PhD^,, and Jenkin S. Hu, MD^*

Departments of *Anesthesiology and Radiology, Taipei Veterans General Hospital; and School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China

Address correspondence and reprint requests to Jenkin S. Hu, MD, Department of Anesthesiology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Rd., Pei-Tou 112, Taipei, Taiwan, ROC. Address e-mail to hshu{at}vghtpe.gov.tw

We report a case of permanent paraplegia in an 81-yr-old patient who had thoracic epidural catheterization performed under general anesthesia for abdominal surgery. The epidural needle was introduced at the T9-10 interspace, and 3 passes were made to locate the epidural space with the loss-of-resistance-to-air technique. During the postoperative epidural pump infusion, the patient was unaware of the progressive motor and sensory impairment. Sensory loss below T11 and paraplegia with no movement of either lower extremity were identified 8 h after surgery. Magnetic resonance imaging demonstrated an intramedullary split-like lesion extending from T4 to T12 and an intramedullary air bubble at T9. Spinal cord injury caused by an intracord catheterization with subsequent local anesthetic injection was diagnosed. Little improvement was noted after large-dose IV methylprednisolone for initial treatment and subsequent rehabilitation for 6 mo. The possible causes of the delayed detection of the neurologic deficits and the timing of performing epidural anesthesia are discussed.

IMPLICATIONS: We report a case of permanent paraplegia after an intracord catheterization during attempted thoracic epidural anesthesia in an anesthetized elderly patient. Subsequent injection of local anesthetic into the misplaced catheter and delayed detection of the postoperative neurologic deficits resulted in this tragic complication.

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