Lower extremity paralysis after thoracotomy or thoracic epidural: image first, ask questions later.

Abstract

When an epidural catheter is present, new motor deficits will often be attributed to a local anesthetic effect, potentially delaying imaging studies, or to an epidural hematoma, ignoring other mechanisms of spinal cord injury. A 69-yr-old female patient undergoing thoracotomy received a preoperative thoracic epidural for postoperative analgesia. Intraoperatively, there was bleeding near the costovertebral junction. Hemorrhage was controlled with cellulose gauze and bone wax. Paralysis developed postoperatively and was initially misdiagnosed as a local anesthetic effect when, in fact, it was caused by an extradural deposit of cellulose gauze and bone wax. We emphasize the need for prompt, definitive imaging when new lower extremity weakness develops after thoracotomy or thoracic epidural analgesia.