title: Monoplegia after combined spinal epidural anesthesia.
abstract: Serious neurological complications after neuraxial block, including permanent neurological injury, are rare in contemporary anesthetic practice. We report a case of a 36 year old female undergoing a venous stripping operation under combined spinal epidural anesthesia (CSE). The CSE procedure was completed after a second attempt at the L4-L5 level and the surgery was completed uneventfully. After full recovery of motor block in the recovery room, the patient was discharged to the surgical ward. Epidural patient controlled analgesia with levobupivacine 0.125% and fentanyl 2 µg/ml was initiated. 10 hours after surgery, right lower limb sensory loss and monoplegia occurred. The epidural catheter was removed and normal MRI findings were noted. After one month of physical therapy treatment and two months follow up the patient was able to walk with the aid of a walking stick. We discuss factors that might have contributed to radiculopathy and neurotoxicity as a cause of neurologic deficit.
authors.affiliation: Department of Anesthesiology and Reanimation, Kocaeli University Faculty of Medicine Hospital, Kocaeli, Turkey. obalaban75@hotmail.com.
authors.forename: Onur
authors.initials: O
authors.lastname: Balaban
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Gürkan
authors.forename: Alparslan
authors.initials: A
authors.lastname: Kuş
authors.forename: Kamil
authors.initials: K
authors.lastname: Toker
authors.forename: Mine
authors.initials: M
authors.lastname: Solak
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D003937:Diagnosis, Differential; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects; D006429:Hemiplegia / Q000139:chemically induced / Q000175:diagnosis* / Q000534:rehabilitation; D006801:Humans; D000077554:Levobupivacaine; D008279:Magnetic Resonance Imaging; D011183:Postoperative Complications / Q000139:chemically induced / Q000175:diagnosis* / Q000534:rehabilitation; D014648:Varicose Veins / Q000601:surgery; D014656:Vascular Surgical Procedures
chemical_list: D000077554:Levobupivacaine; D005283:Fentanyl; D002045:Bupivacaine