title: Permanent neurologic symptoms after prolonged epidural analgesia.
abstract: OBJECTIVE
  Although transient neurologic symptoms may occur after neuraxial anesthetics with lidocaine, permanent neurologic symptoms (PNS) are unusual after uncomplicated continuous epidural analgesia (CEA). This report demonstrates that PNS may follow CEA uncomplicated by paresthesias, dural puncture, spinal hemorrhage, or intravascular local anesthetic injection; and performed with bupivacaine alone administered at high dosages with vasoconstrictors over a prolonged time period.
  
  
  METHODS
  An obstetrical patient developed fixed left L5-S1 sensorimotor radiculopathy following L5-S1 level CEA with bupivacaine alone administered at high doses (270 mg) with a vasoconstrictor (epinephrine, 225 mg) over a prolonged time period (62 hours).
  
  
  CONCLUSIONS
  CEA should be administered at higher lumbar levels for labor analgesia rather than at lumbosacral levels that may require higher volumes and concentrations of local anesthetics with greater potential for local anesthetic neurotoxicity. Local anesthetics with vasoconstrictors should only be used as sentinel markers of unrecognized intravascular entry, rather than as primary local anesthetics during CEA to avoid any potential for ischemic neuropathy.
authors.affiliation: Department of Public Health and Preventive Medicine, the Pain Mastery Center of Louisiana, Lousiana State University Health Sciences Center in New Orleans, Louisiana 70112, USA. jdiaz@lsuhsc.edu
authors.forename: James H
authors.initials: JH
authors.lastname: Diaz
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Gould