Paraplegia 15 minutes after thoracic epidural puncture (original) (raw)

European Journal of Anaesthesiology, 2006

Abstract

A-457 Paraplegia 15 minutes after thoracic epidural puncture C. Wutti1, J. Tschmelitsch2, M. Jagoditsch2, J. Vogelsang3, M. Zink1 1Department of Anaesthesiology and Intensive Care Medicine, BHB St. Veit/Glan and Medical University of Graz; 2Department of Surgery, BHB St. Veit/Glan, Austria Background: Spinal haematoma with neurologic sequela is a serious complication after epidural catheterization with a frequency of 1:150.000 (1). Most of these cases are correlated with anticoagulation therapy or pre-existing coagulation disorders and have an onset of neurologic symptoms after approximately 15 hours (2). Case Report: We report the case of a 61 years old man, suffering from an acute exacerbation of a chronic pancreatitis with severe persistent pain (VAS 10). As there was good pain control with epidural analgesia in former episodes of his illness an epidural catheter was inserted between thoracic segment 8 and 9. Medical history and laboratory results showed no coagulation disorders. Pain decreased to VAS 1 to 2 for the next 6 days. On the sixth day the catheter dislocated accidentally. Following intravenous application of analgesics (Piritramid, Metamizol) was ineffective (VAS 7). Therefore we decided to insert a new epidural catheter (thoracic 7/8). Again laboratory results showed normal coagulation parameters and the interval to the last dose of 40 mg Enoxaparin was more than sixteen hours. After three attempts the catheter was inserted. A hemorragheous backflow occurred and the catheter was pulled back 1 cm. Now hemorrhage stopped. Ten minutes later the patient reported severe back pain (VAS 10) with a punctum maximum 3 segments below the puncture site, again 5 minutes later paraplegia of the legs developed. Computertomography and MRI revealed a large haematoma with neuronal compression between T4 to T9. Emergency hemilaminectomia for haematoma evacuation was performed 1 hour later and a large bleeding venous network was detected. 12 days after this procedure the patient left the hospital without any neurologic disorders. Conclusion: Paraplegia due to iatrogenic spinal hemorrhage can develop within a few minutes after epidural puncture. If severe pain a few segments below puncture site is observed one should consider the possibility of a spinal bleeding. If spinal decompression is performed without time delay neurological prognosis can be excellent. References: 1 Tryba M. Anasthesiol Intensivmed Notfallmed Schmerzther 1993; 28: 179–81. 2 Vandermeulen EP, Van Aken H, Vermylen J. Anesth Analg 1994; 79: 1165–177.

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