Lower Extremity Paralysis After Thoracotomy or Thoracic Epidural: Image First, Ask Questions Later

Abstract

BACKGROUND: 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. METHODS: A 69-yr-old female patient undergoing thoracotomy received a preoperative thoracic epidural for postoperative analgesia. RESULTS: 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. CONCLUSIONS: We emphasize the need for prompt, definitive imaging when new lower extremity weakness develops after thoracotomy or thoracic epidural analgesia.