title: A patient with postpolio syndrome developed cauda equina syndrome after neuraxial anesthesia: A case report.
abstract: Combined spinal anesthesia and postoperative epidural analgesia is widely used in orthopedic surgery. Uncommon but serious neurologic complications of neuraxial anesthesia (NA) include direct trauma during needle or catheter insertion, central nervous system infections, and neurotoxicity of local anesthetics. Cauda equina syndrome (CES) is a rare complication after NA but can result in severe neurologic deterioration that may require surgical intervention. We present a case of a 69-year-old woman with postpolio syndrome who developed CES after combined spinal anesthesia and postoperative epidural analgesia. Perioperative observations and follow-up examinations, including magnetic resonance imaging, revealed no evidence of direct needle- or catheter-induced trauma, spinal hematoma, spinal ischemia, intraneural anesthetic injection, or infection. We speculate that CES symptoms were observed because of enhanced sensitivity to a combination of regional anesthetic technique-related microtrauma and neurotoxicity of bupivacaine and ropivacaine. Thus, practitioners should be aware that patients with preexisting neurologic diseases may be at increased risk for CES after NA.
authors.affiliation: Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC.
authors.forename: Wei-Cheng
authors.initials: WC
authors.lastname: Tseng
authors.affiliation: Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC.
authors.forename: Zhi-Fu
authors.initials: ZF
authors.lastname: Wu
authors.affiliation: Department of Anesthesiology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC.
authors.forename: Wen-Jinn
authors.initials: WJ
authors.lastname: Liaw
authors.affiliation: Department of Orthopaedics, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC.
authors.forename: Su-Yang
authors.initials: SY
authors.lastname: Hwa
authors.affiliation: Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC. Electronic address: rvolvo307@gmail.com.
authors.forename: Nan-Kai
authors.initials: NK
authors.lastname: Hung
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects* / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D004576:Electromyography; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D015207:Osteoarthritis, Hip / Q000601:surgery; D011128:Polyradiculopathy / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology*; D016262:Postpoliomyelitis Syndrome / Q000150:complications*; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D008012:Lidocaine; D005283:Fentanyl; D002045:Bupivacaine; D004837:Epinephrine
keywords: Caudal equina syndrome; Epidural analgesia; Neuraxial anesthesia; Postpolio syndrome; Spinal anesthesia