Perioperative stroke associated with postoperative epidural analgesia.
A patient with an epidural catheter for postoperative analgesia developed a stroke in association with a hypotensive episode resulting from a bolus of local anesthetic. After undergoing resection for femoral chondrosarcoma under epidural anesthesia, the patient received a continuous infusion of epidural morphine for postoperative analgesia. Lidocaine 1% (10 mL in divided doses) was administered through the catheter for breakthrough pain. The patient experienced a hypotensive episode and was noted to have a motor and cortical sensory deficit of the left arm and leg 8 hours after the hypotensive episode. Clinical presentation and subsequent workup were consistent with a watershed infarction. The patient recovered full neurologic function before discharge. Postoperative hypotension from epidural analgesia may be associated with stroke; however, a cause-and-effect relationship usually cannot be established with certainty.
Wu
C L
CL
Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, NY, USA. chwu@jhmi.edu
Francisco
D R
DR
Benesch
C G
CG
D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000009:adverse effects*; D001132:Arm / Q000294:innervation; D002544:Cerebral Infarction / Q000209:etiology; D002813:Chondrosarcoma / Q000601:surgery; D005266:Femoral Neoplasms / Q000601:surgery; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007866:Leg / Q000294:innervation; D008012:Lidocaine / Q000009:adverse effects*; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D009069:Movement Disorders / Q000209:etiology; D011183:Postoperative Complications; D012678:Sensation Disorders / Q000209:etiology; D020521:Stroke / Q000209:etiology*
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D008012:Lidocaine