Lung Cancer Research Today is a free monthly online journal that collates and summarizes the latest research about Lung Cancer, including details on symptoms, smoking, genetics, treatment, causes.

Lower extremity paralysis after thoracotomy or thoracic epidural: image first, ask questions later.

Butterworth J, Douglas-Akinwande A

Department of Anesthesia, Indiana University School of Medicine, Indianapolis, Indiana, USA. jfbutter@iupui.edu

BACKGROUND: When an epidural catheter is present, new motor deficits will often be attributed to a local anesthetic effect, potentially delaying imaging studies, or to an epidural hematoma, ignoring other mechanisms of spinal cord injury. METHODS: A 69-yr-old female patient undergoing thoracotomy received a preoperative thoracic epidural for postoperative analgesia. RESULTS: Intraoperatively, there was bleeding near the costovertebral junction. Hemorrhage was controlled with cellulose gauze and bone wax. Paralysis developed postoperatively and was initially misdiagnosed as a local anesthetic effect when, in fact, it was caused by an extradural deposit of cellulose gauze and bone wax. CONCLUSIONS: We emphasize the need for prompt, definitive imaging when new lower extremity weakness develops after thoracotomy or thoracic epidural analgesia.

Published 20 December 2006 in Anesth Analg, 104(1): 201-3.
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