Paraplegia following epidural analgesia

Abstract

Paraplegia following epidural analgesia is an uncommon occurrence and the number of cases recorded in the literature is few. Epidural analgesia is generally regarded as a safe method with few complications and the number of administrations throughout the world without complications must run into many thousands.Whatever the advantages of epidural analgesia may be and, however safe it may appear, the likelihood of paraplegia following such a technique must not be overlooked when assessing a person's suitability for epidural block. When this complication occurs it is a tragedy for the patient and a constant reminder to those who have borne the responsibility for choosing such a method. This paper describes one such case in which a retropubic prostatectomy carried out on a fit 62-year old man using epidural analgesia was followed immediately by paraplegia. There was some improvement initially, but he was left with a permanent partial paresis of both hips. He died some sixteen months later from metastatic carcinoma of the prostate. CASE REPORTAB, a European male aged 62 years, was first seen in September 1966 complaining of frequency, a thin repetitive stream and occasional urgency, present for one year. He found it necessary to void twice each night and hourly during the day. There had been no pain, haematuria, or urethral scalding and apart from the local urinary symptoms he felt well. In 1960 he had had herpes zoster affecting the ophthalmic division of the fifth left cranial nerve. He was a well nourished, fit-looking man, normotensive (1 70/90), with no abnormal findings in the cardiovascular, respiratory or central nervous systems. His abdomen was likewise normal and, on rectal examination, the prostate, was firm, irregular andenlarged to an estimated weight of 30g. Laboratory investigations were as follows : haemoglobin 15g %, PCV 43 %, urea 24mg%, serum acid phosphatase ~K A units, midstream urine acellular and sterile. A chest X-ray was normal. The intravenous pyelogram showed both kidneys to be of normal size, shape and structure, with normal function, and there was no visible abnormality of

Post-operative paraplegia with spinal myoclonus possibly caused by epidural anaesthesia: case report

“…Though the epidural injection of morphine hydrochloride and epinephrine (Urquhart-Hay, 1969), and the percutaneous nephrolithotresis may also have given rise to or have affected the neurological complications, it is uncertain whether they had a direct relation to the onset of the paralysis.…”

Spinal cord ischemia following thoracotomy without epidural anesthesia

“…15 Notably, the process of ischemia was not identified by the computed tomography scan performed in our case. An MRI scan is far more sensitive in excluding potential causes such as spinal cord compression, or detecting other causes such as spinal cord ischemia.…”

Perioperative spinal cord infarction in nonaortic surgery: report of three cases and review of the literature

“…A concerning finding was that, as with Case 1, an epidural-associated SCI may occur without any warning signs during an otherwise unremarkable anesthetic in patients with only mild systemic medical conditions [11,17].…”

“…Both Cases 1 and 3, and others (eg, Ref. [17]) had active cancer disease. Pregnancy is also a hypercoagulable state and it has been associated with SCI [25].…”