title: Epidural analgesia masked the diagnosis of femoral neuropathy following renal transplantation.
abstract: Kidney transplantation related femoral neuropathy can mimic epidural catheter related radiculopathy in clinical presentation. Anesthesiologists should keep this possibility in mind when performing epidural anesthesia or analgesia for kidney transplantation. We present a 52-year-old male who after undergoing cadaveric kidney transplantation under general anesthesia in combination with epidural analgesia made possible by catheterization via T11-12 interspace for reinforcement of anesthesia and for postoperative patient-controlled epidural analgesia (PCEA) sustained sensory disturbance and muscle weakness of the lower limbs. These symptoms did not improve after discontinuation of the PCEA. Epidural hematoma with secondary radiculopathy was contemplated initially. Serial examinations including thoracic-lumbar CT scan, abdominal sonography, electromyogram and nerve conduction study were thus performed. The final diagnosis turned out to be surgical procedure related femoral neuropathy. We believe this is the first instance ever reported about the dilemma in making a predicative diagnosis from two conditions near akin in kidney transplantation. Accurate diagnosis made through serial image and electrophysiologic studies are essential to appropriate management.
authors.affiliation: Department of Anesthesiology, Taipei Veterans General Hospital, Taiwan, ROC.
authors.forename: Hou-Cheng
authors.initials: HC
authors.lastname: Peng
authors.forename: Cheng-Ming
authors.initials: CM
authors.lastname: Tsao
authors.forename: Ya-Chun
authors.initials: YC
authors.lastname: Chu
authors.forename: Mei-Yung
authors.initials: MY
authors.lastname: Tsou
mesh_terms: D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D020428:Femoral Neuropathy / Q000175:diagnosis*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*