Neuropathies masquerading as an epidural complication

Abstract

Larry Kahn BSC (med), MB Crib Neuropathies masquerading as an epidural complicationPurpose: The purpose of this report is to emphasise the role of the Acute Pain Service in managing local anaesthetic epidural infusions for postoperative pain management, the importance of vigilant monitoring, and to offer some guidelines to using local anaesthetic epidural infusions.Clinical features: A 34-yr-old man with long-standing insulin dependent diabetes mellitus underwent a total proctocolectomy for inflammatory bowel disease. A "1"9-I 0 epidural catheter was placed prior to induction of general anaesthesia, Postoperatively, a continuous epidural infusion of fentanyt/bupivacaine was used for postoperative pain management. Total lithotomy time was four hours, On day four he was noted to have complete nght sided femoral and left sided lateral femoral cutaneous nerve of thigah neuropathies, A computerisecl tomography scan and a magnetic resonance imaging excluded a central lesion. Electromyelography confirmed peripheral nerve injunes.Conclusion: This patient's neurological deficits were not due to the epidural analgesia. However, epidural infusion of local anaesthetic caused a delay in recognising a potential neurological complication, When using local anaesthetic epidural infusions, it is important to exclude other causes of motor block before attributing it to the local anaesthetic.

Anesthetic considerations in diabetic patients. Part I: preoperative considerations of patients with diabetes mellitus

“…Deleterious hypotension can occur, this hemodynamic instability being of greater significance in diabetic patients with coronary artery or cerebrovascular diseases. In addition, DM is a risk factor for development of epidural abscesses following epidural anesthesia [77,78]. Eastwood [79] reported a case of anterior spinal artery syndrome arising as a complication of epidural anesthesia in a patient with diabetic scleredema.…”

Anaesthetic considerations in metabolic syndrome X

“…Diabetic peripheral neuropathy presenting after an epidural block may mimic an anaesthetic complication of epidural block. [3] Spinal block in an uncontrolled hypertensive may cause a detrimental fall in blood pressure. Hence peripheral nerve block was considered as the safest option.…”