title: Two cases of cauda equina syndrome following spinal-epidural anesthesia.
abstract: OBJECTIVE
  Cauda equina syndrome (CES) is a well-known complication of spinal and epidural anesthesia. Previous reports have implicated lidocaine, chloroprocaine, and procaine in its etiology, but not bupivacaine.
  
  
  METHODS
  A 63-year-old man underwent transurethral resection of the prostrate for which he received bupivacaine with glucose intrathecally. Postoperative, he had difficulty in urination and defecation, and magnetic resonance imaging revealed spinal stenosis at the L1-L2 level. The second patient was a 70-year-old woman who underwent hip replacement surgery using a combined spinal-epidural technique. Postoperative, after 42 hours, when the epidural infusion of bupivacaine was stopped, the patient had difficulty in urination and defecation. No anatomical abnormality was found on magnetic resonance imaging.
  
  
  RESULTS
  The two patients developed cauda equina syndrome following bupivacaine with glucose injected spinally, and bupivacaine without glucose injected in a combined spinal-epidural technique.
  
  
  CONCLUSIONS
  This case report describes two cases of CES following the use of bupivacaine. The first patient had spinal stenosis which could explain this complication; however the explanation for CES in the second patient is uncertain and consequently speculative. We have discussed the possible contributing factors but believe that the etiology of CES in the second patient remains unknown.
authors.affiliation: Department of Anaesthesiology, Orebro Hospital Medical Center, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Kubina
authors.forename: A
authors.initials: A
authors.lastname: Gupta
authors.forename: A
authors.initials: A
authors.lastname: Oscarsson
authors.forename: K
authors.initials: K
authors.lastname: Axelsson
authors.forename: M
authors.initials: M
authors.lastname: Bengtsson
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D002420:Cauda Equina; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000503:physiopathology; D011183:Postoperative Complications / Q000209:etiology*; D011467:Prostate / Q000601:surgery; D013130:Spinal Stenosis / Q000209:etiology
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine