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A patient with postpolio syndrome developed cauda equina syndrome after neuraxial anesthesia: A case report.
J Clin Anesth. 2017 Feb; 37:49-51.JC

Abstract

Combined spinal anesthesia and postoperative epidural analgesia is widely used in orthopedic surgery. Uncommon but serious neurologic complications of neuraxial anesthesia (NA) include direct trauma during needle or catheter insertion, central nervous system infections, and neurotoxicity of local anesthetics. Cauda equina syndrome (CES) is a rare complication after NA but can result in severe neurologic deterioration that may require surgical intervention. We present a case of a 69-year-old woman with postpolio syndrome who developed CES after combined spinal anesthesia and postoperative epidural analgesia. Perioperative observations and follow-up examinations, including magnetic resonance imaging, revealed no evidence of direct needle- or catheter-induced trauma, spinal hematoma, spinal ischemia, intraneural anesthetic injection, or infection. We speculate that CES symptoms were observed because of enhanced sensitivity to a combination of regional anesthetic technique-related microtrauma and neurotoxicity of bupivacaine and ropivacaine. Thus, practitioners should be aware that patients with preexisting neurologic diseases may be at increased risk for CES after NA.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Tseng WC
Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC.
Wu ZF
Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC.
Liaw WJ
Department of Anesthesiology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC.
Hwa SY
Department of Orthopaedics, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC.
Hung NK
Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC. Electronic address: rvolvo307@gmail.com.

MeSH

AgedAmidesAnalgesia, EpiduralAnalgesia, Patient-ControlledAnalgesics, OpioidAnesthesia, SpinalAnesthetics, LocalArthroplasty, Replacement, HipBupivacaineElectromyographyEpinephrineFemaleFentanylHumansLidocaineMagnetic Resonance ImagingOsteoarthritis, HipPolyradiculopathyPostpoliomyelitis SyndromeRopivacaine

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

28235527

Citation

Tseng, Wei-Cheng, et al. "A Patient With Postpolio Syndrome Developed Cauda Equina Syndrome After Neuraxial Anesthesia: a Case Report." Journal of Clinical Anesthesia, vol. 37, 2017, pp. 49-51.
Tseng WC, Wu ZF, Liaw WJ, et al. A patient with postpolio syndrome developed cauda equina syndrome after neuraxial anesthesia: A case report. J Clin Anesth. 2017;37:49-51.
Tseng, W. C., Wu, Z. F., Liaw, W. J., Hwa, S. Y., & Hung, N. K. (2017). A patient with postpolio syndrome developed cauda equina syndrome after neuraxial anesthesia: A case report. Journal of Clinical Anesthesia, 37, 49-51. https://doi.org/10.1016/j.jclinane.2016.09.032
Tseng WC, et al. A Patient With Postpolio Syndrome Developed Cauda Equina Syndrome After Neuraxial Anesthesia: a Case Report. J Clin Anesth. 2017;37:49-51. PubMed PMID: 28235527.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A patient with postpolio syndrome developed cauda equina syndrome after neuraxial anesthesia: A case report. AU - Tseng,Wei-Cheng, AU - Wu,Zhi-Fu, AU - Liaw,Wen-Jinn, AU - Hwa,Su-Yang, AU - Hung,Nan-Kai, Y1 - 2016/12/27/ PY - 2016/03/10/received PY - 2016/09/08/revised PY - 2016/09/28/accepted PY - 2017/2/26/entrez PY - 2017/2/27/pubmed PY - 2017/9/15/medline KW - Caudal equina syndrome KW - Epidural analgesia KW - Neuraxial anesthesia KW - Postpolio syndrome KW - Spinal anesthesia SP - 49 EP - 51 JF - Journal of clinical anesthesia JO - J Clin Anesth VL - 37 N2 - Combined spinal anesthesia and postoperative epidural analgesia is widely used in orthopedic surgery. Uncommon but serious neurologic complications of neuraxial anesthesia (NA) include direct trauma during needle or catheter insertion, central nervous system infections, and neurotoxicity of local anesthetics. Cauda equina syndrome (CES) is a rare complication after NA but can result in severe neurologic deterioration that may require surgical intervention. We present a case of a 69-year-old woman with postpolio syndrome who developed CES after combined spinal anesthesia and postoperative epidural analgesia. Perioperative observations and follow-up examinations, including magnetic resonance imaging, revealed no evidence of direct needle- or catheter-induced trauma, spinal hematoma, spinal ischemia, intraneural anesthetic injection, or infection. We speculate that CES symptoms were observed because of enhanced sensitivity to a combination of regional anesthetic technique-related microtrauma and neurotoxicity of bupivacaine and ropivacaine. Thus, practitioners should be aware that patients with preexisting neurologic diseases may be at increased risk for CES after NA. SN - 1873-4529 UR - https://www.unboundmedicine.com/medline/citation/28235527/A_patient_with_postpolio_syndrome_developed_cauda_equina_syndrome_after_neuraxial_anesthesia:_A_case_report_ DB - PRIME DP - Unbound Medicine ER -