title: Cauda equina syndrome following combined spinal and epidural anesthesia: a case report.
abstract: OBJECTIVE
  To describe a case of complete neurological recovery from cauda equina syndrome lasting ten months following spinal anesthesia with 0.5% hyperbaric bupivacaine and epidural anesthesia with ropivacaine, and to discuss the possible mechanisms involved.
  
  
  RESULTS
  A 79-yr-old man with Paget's disease was scheduled for surgery to remove a skin tumour below his scrotum. He had no history of radicular pain or back pain and no pre-existing neurologic disorder. Surgery was performed with the patient in the supine position. He received 0.5% hyperbaric bupivacaine intrathecally for the procedure and ropivacaine through an epidural catheter for postoperative pain management. After catheter removal, the patient developed urinary retention, fecal incontinence, and perianal hypoesthesia. A lumbosacral magnetic resonance imaging (MRI) revealed no tumour, infarction, degeneration, spinal stenosis, or compression on the cauda equina nerve roots. A diagnosis of cauda equina syndrome was made, and the etiology was thought to be toxicity of bupivacaine either alone or in combination with ropivacaine. After three months, the patient reported some return of sensation at the perianal area, with complete resolution at four months. At the ten-month follow-up visit, the patient had recovered from his urinary retention and fecal incontinence.
  
  
  CONCLUSIONS
  This case suggests that spinal anesthesia, even with an ordinary dose of hyperbaric 0.5% bupivacaine, might induce cauda equina syndrome in older patients.
authors.affiliation: Department of Anesthesiology, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan. jitukato@med.nihon-u.ac.jp.
authors.forename: Jitsu
authors.initials: J
authors.lastname: Kato
authors.affiliation: Department of Anesthesiology, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Jumpei
authors.initials: J
authors.lastname: Konishi
authors.affiliation: Department of Anesthesiology, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Humihiko
authors.initials: H
authors.lastname: Yoshida
authors.affiliation: Department of Anesthesiology, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Furuya
authors.affiliation: Department of Anesthesiology, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kashiwai
authors.affiliation: Department of Anesthesiology, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Shoko
authors.initials: S
authors.lastname: Yokotsuka
authors.affiliation: Department of Anesthesiology, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Dai
authors.initials: D
authors.lastname: Gokan
authors.affiliation: Department of Anesthesiology, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Setsuro
authors.initials: S
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects*; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000517:prevention & control; D011128:Polyradiculopathy / Q000139:chemically induced*; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D002045:Bupivacaine