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Spinal artery syndrome masked by postoperative epidural analgesia

1997; Springer Science+Business Media; Volume: 44; Issue: 11 Linguagem: Inglês

10.1007/bf03013341

1496-8975

Stephan M. Linz, Christopher Charbonnet, Maged Mikhail, Nippon Vadehra, Vladimir Zelman, Ronald L. Katz, Duraiyah Thangathurai,

Aortic Disease and Treatment Approaches

We report a case of a patient who developed a postoperative anterior spinal artery syndrome that was masked by the use of epidural analgesia. We wish to alert other anaesthetists that the use of epidural anaesthesia in this setting may mask the symptoms and delay the diagnosis of this rare complication. The patient was a 22-yr-old obese man with metastatic testicular carcinoma who underwent a left-sided thoracoabdominal retropentoneal tumour resection. A lumbar epidural catheter was placed preoperatively for pain management. Postoperatively, the patient developed bilateral lower extremity weakness, which was at first attributed to epidural administration of local anaesthetics. Despite discontinuation of the local anaesthetics, the symptoms persisted. Further work-up led to the diagnosis of anterior spinal artery syndrome. The patient was sent to a rehabilitation hospital and had a partial recovery. Antenor spinal artery syndrome can occur following retropentoneal surgery. It is important to recognize the potential for this complication when postoperative epidural analgesia is contemplated, especially following a left-sided surgical dissection. The use of epidural local anaesthetics iminediately after surgery delays the diagnosis of a postoperative neurological deficit. Moreover, when the deficit is recognized the epidural itself may be falsely blamed for postoperative paraplegia. If epidural analgesia is used, opioids may be preferred over local anaesthetics in the iminediate postoperative period to prevent masking of an antenor spinal artery syndrome.