Intradural Herniation of a Thoracic Disc Causing Paraplegia Coincident with Epidural Anesthesia

Matsuura, John A.; Makhoul, Raymond G.; Posner, Marc P.; Smith, J. W. G.; Litwack, Robert S.

doi:10.1097/00000539-199704000-00041

Cited by 7 publications

(4 citation statements)

References 19 publications

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“…One previous report mentions paraplegia associated with disc herniation and epidural analgesia (52). The patient in our study undergoing radical prostectomy with a thoracic epidural catheter placement at Th 11−12 reported postoperative back pain and paravertebral sensibility disturbances the day after surgery.…”

Section: Discussionmentioning

confidence: 99%

Pain relief and safety after major surgery A prospective study of epidural and intravenous analgesia in 2696 patients

Flisberg

Rudin

Linnér

et al. 2003

Acta Anaesthesiol Scand

105

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Pain relief and safety after major surgery A prospective study of epidural and intravenous analgesia in 2696 patients. Link to publication Citation for published version (APA): Flisberg, P., Rudin, Å., Linnér, R., & Lundberg, C. J. F. (2003). Pain relief and safety after major surgery A prospective study of epidural and intravenous analgesia in 2696 patients. Acta Anaesthesiologica Scandinavica, 47(4), 457-465. DOI: 10.1034457-465. DOI: 10. /j.1399457-465. DOI: 10. -6576.2003 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Background: Adverse effects may still limit the use of continuous epidural and intravenous analgesia in surgical wards. This study postulated that postoperative epidural analgesia was more efficient, and had fewer side-effects than intravenous morphine. The aim was to investigate efficacy, adverse effects and safety of the treatments in a large patient population. Methods: During a five-year period 2696 patients undergoing major surgery, received either epidural or intravenous analgesia for postoperative pain relief. The patients were prospectively monitored in surgical wards. Pain was evaluated with a numeric rating scale (0Ð10) at rest/mobilization. Treatment duration, respiratory depression, sedation/hallucinations/ nightmares/confusion, nausea/vomiting, pruritus, orthostatism/ leg weakness, and insufficient pain relief were registered. Pain relief for all patients aimed at a pain scoring of less than 4 at rest. Results: Epidural analgesia was used in 1670 patients, and intravenous morphine in 1026 patients. Patients with epidural analgesia experienced less pain both at rest and during mobilization. Insufficient treatment effects such as dose adjustments, orthostatism/leg weakness, and pruritus were more common in the epidural group. Respiratory depression and sedation/hallucinations/nightmares/confusion occurred more often in the intravenous group. Thoracic epidural catheters caused a lower incidence of motor blockade compared to lumbar catheter placements. Conclusion:In a large patient population the use of epidural and intravenous postoperative analgesia was considered safe in surgical wards, and the incidence of adverse effects was low.Patients with epidural analgesia experienced overall less pain, while opioid related side-effects were more common with intravenous morphine analgesia.

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Section: Discussionmentioning

confidence: 99%

Pain relief and safety after major surgery A prospective study of epidural and intravenous analgesia in 2696 patients

Flisberg

Rudin

Linnér

et al. 2003

Acta Anaesthesiol Scand

105

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“…Complications of regional spinal anesthesia are; intravascular injection of anesthetic media throughout spinal veins causing toxicity, inaccurately introduced anesthetic agent into the subarachnoid space which may cause central nervous system (CNS) dysfunction, high level anesthesia causing respiratory or CNS dysfunction, and dorsal pain or post-anesthesia headache. Potential causes of paraplegia coincident with spinal anesthesia includes: epidural and subdural hematoma associated with systemic heparinization or platelet dysfunctions, spinal cord ischemia associated with thrombosis of anterior spinal artery, spinal cord traumas related to direct needle injuries or chemical toxicity of the anesthetic agents [10-14,15]. In our case, lack of evidence for hematoma and normal signal intensity of the spinal cord in MRI ruled out these complications.…”

Section: Discussionmentioning

confidence: 72%

Thoracic disc herniation causing transient paraplegia coincident with epidural anesthesia: a case report

Kaya

Özgöçmen

2009

Cases J

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Neurological deficits following epidural or spinal anesthesia are extremely rare. Transient paraplegia following epidural anesthesia in a patient with thoracic disc herniation has been presented. A 44-year-old woman developed paraplegia during the operation for vascular surgery of her legs under epidural anesthesia. Epidural hematoma or spinal cord ischemia was ruled out by magnetic resonance imaging of the thoracic and lumbar spine in which protruded disc at T11-12 level compressing the spinal cord has been verified. Patient responded well to steroid treatment and rehabilitation interventions. Physicians should be aware of preceding disc protrusions, which may have detrimental effects on spinal cord perfusion, as a cause of persistent or transient paraplegia before epidural anesthesia procedure. MRI is a valuable imaging option to rule out epidural anesthesia complications and coexisting pathologies like disc herniations.

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“…The management of intradural extension of thoracic disc herniation is problematic and not infrequently encountered. [19][20][21][22][23][24] Dural breaches are not uncommon with anterolateral approaches but typically these are small and can be managed with little risk.…”

Section: Discussionmentioning

confidence: 99%

Management of massive calcified transdural thoracic disk herniation

Al-Barbarawi

Sekhon

2003

Journal of Clinical Neuroscience

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Intradural Herniation of a Thoracic Disc Causing Paraplegia Coincident with Epidural Anesthesia

Cited by 7 publications

References 19 publications

Pain relief and safety after major surgery A prospective study of epidural and intravenous analgesia in 2696 patients

Pain relief and safety after major surgery A prospective study of epidural and intravenous analgesia in 2696 patients

Thoracic disc herniation causing transient paraplegia coincident with epidural anesthesia: a case report

Management of massive calcified transdural thoracic disk herniation

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