Paraplegia following Epidural Anaesthesia

Davies, Alan; Solomon, Basil; Levene, Arnold

doi:10.1136/bmj.2.5097.654

Cited by 41 publications

(11 citation statements)

References 8 publications

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“…Spinal cord infarction following epidural anaesthesia has been attributed to a continuous infusion of bupivacaine with epinephrine; however, the cord infarct was attributed to intra‐operative hypotension with decreased cord perfusion (14). Other cases of spinal cord infarction following epidural anaesthesia have been caused by decreased spinal artery perfusion pressure secondary to hypotension in addition to the vasoconstriction caused by epinephrine (15, 16). Some studies show that local anaesthetics containing epinephrine do not decrease spinal artery perfusion (17); however, others show that epidural administration of epinephrine can decrease spinal cord blood flow by up to 50% and this percentage is even higher in the presence of hypotension (18).…”

Section: Discussionmentioning

confidence: 99%

Post‐operative paraplegia following spinal cord infarction

Weinberg¹,

Harvey²,

Marshall

2002

Acta Anaesthesiol Scand

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Thoracic epidural analgesia is a frequently utilised technique. Neurological complications are uncommon, but of grave consequence with significant morbidity. Spinal cord infarction following epidural anaesthesia is rare. We present a case where a hypertensive patient underwent an elective sigmoid colectomy under combined general/epidural anaesthesia for a suspected malignant abdominal mass. An epidural infusion was used for intra-operative and post-operative analgesia. During surgery, the blood pressure was labile and she was hypotensive. Postoperatively, the patient became confused, pyrexial and tachycardic and developed systemic inflammatory response syndrome requiring intensive care management. She developed a flaccid paralysis at L3 level with areflexia, analgesia and impaired sensation. A spinal cord infarct in the region of the conus extending into the thoracic cord was diagnosed. Complications of epidural anaesthesia are easily recognised when they develop immediately; their relationship to the anaesthesia and the post-operative period may be misjudged or underestimated when they appear after a delay, if neurological signs are masked by lack of patient cooperation and drowsiness or if the epidural anaesthesia is prolonged by long-acting drugs. New neurological deficits should be evaluated promptly to document the evolving neurological status and further testing or intervention should be arranged if appropriate. The association with epidural anaesthesia as a cause of paraplegia is reviewed. The aetiological factors that may have contributed to this tragic neurological complication are discussed.

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Section: Discussionmentioning

confidence: 99%

Post‐operative paraplegia following spinal cord infarction

Weinberg¹,

Harvey²,

Marshall

2002

Acta Anaesthesiol Scand

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“…This complication was attributed to contamination of the syringe, during boiling, by acriflavine that had found its way to the sterilizer. Davies et al (1958) reported the case of an elderly patient who had thrombosis of the E/ anterior spinal artery with permanent paraplegia after epidural injection of an anaesthetic for a femoral hernia operation. Their technique was not that discussed in this paper: the injection was between L 1 and L 2, and 27 ml.…”

Section: Discussionmentioning

confidence: 99%

A Comparison Between Epidural Anaesthesia and Bed Rest in Sciatica

Coomes¹

1961

BMJ

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“…Finally, one must not forget that detrimental effects, such as para plegia, may result from long lasting anesthetics (efocaine) injected into peripheral nerves (16,28) or after epidural anesthesia (14,18). Agents injected extrathecally will eventually reach the subthecal space in concentrations high enough to cause subthecal spinal anesthesia (20).…”

Section: Discussionmentioning

confidence: 99%