'Shared spinal cord' scenario: paraplegia following abdominal aortic surgery under combined general and epidural anaesthesia

Abstract

Serious neurological complications of abdominal aortic vascular surgery are rare but devastating for all involved. When epidural blockade is part of the anaesthetic technique such complications may be attributed to needles, catheters or drugs. We present a patient who developed paraplegia following an elective abdominal aortic aneurysm repair. Continuous epidural blockade was part of the anaesthetic technique and postoperative analgesia. In this case the spinal cord damage was explained by ischaemia caused by the aortic surgery. This event has made us aware of a rare complication associated with abdominal aortic surgery and highlighted safety aspects of epidural anaesthesia in such patients.

Regional anaesthesia for limb surgery: a review of anaesthetists’ beliefs and practice in the Oxford region*

“…Severe complications associated with regional anaesthesia techniques are rare but potentially devastating for both patient and anaesthetist. When peri‐operative neurological complications do occur in the setting of combined general anaesthesia and regional anaesthesia, they are not inevitably a consequence of the regional anaesthetic technique [10–15]. Case reports highlight the potential danger of spinal cord injury if central blocks and indeed some peripheral nerve blocks are performed in anaesthetised patients [16–18].…”

Paraplegia após revascularização cirúrgica do miocárdio: relato de caso

“…Blood flow could possibly be altered by direct trauma, reduced perfusion pressure, or venous congestion. Ischemic myelopathy is the consequence of the transitory or permanent interruption of the spinal cord circulation, which is seen more often in surgical procedures, especially thoracolumbar surgery, and rarely after myocardial revascularization 5,6, [15][16][17] .…”