Transient Paraplegia due to Accidental Intrathecal Bupivacaine Infiltration Following Pre-Emptive Analgesia in a Patient With Missed Sacral Dural Ectasia

Abstract

This unexpected complication has been reported only in the pediatric literature before. It is important to look for the presence of lumbosacral dural anomalies before planning caudal epidural injections in adults also. Sacral dural ectasia and other lumbosacral anomalies must be recognized as contraindications for caudal epidural pre-emptive analgesia for spine surgery. Other modes of postoperative pain relief should be tried in these patients.

Regional Anesthesia in Patients With Preexisting Neurologic Disease

“…127,128 Dural ectasia is also known to occur in patients with Patau syndrome (trisomy 13), 129 Ehlers-Danlos syndrome, neurofibromatosis type I, and ankylosing spondylitis. 130 Several case reports have described inadvertent dural puncture during caudal anesthesia 129,131,132 and incomplete spinal anesthesia 133 in patients with dural ectasia.…”

Neuraxial block in a patient with dural ectasia

“…[5] In this case, the patient had a caudal block before start of the procedure, which contributed to the paraplegia.…”

Paraplegia following caudal block in a child with Burkitt’s lymphoma

“…Although these tumors are highly aggressive, they are potentially curable with chemotherapy. Epidural involvement and onset of paraplegia because of Burkitt’s lymphoma has been well documented (4–9). Although major neurological complications following caudal epidural block are rare, they can be devastating both for the patients and for the personnel involved in their management.…”