2008 Volume 28 Issue 1 Pages 58-61
An 80-year-old man was scheduled for total knee arthroplasty under combined spinal and epidural anesthesia. He had no neurological symptoms before surgery. During continuous epidural infusion for postoperative analgesia, weakness of the left leg was noted. After continuous epidural injection was stopped, however, the left leg pain reappeared and epidural infusion was re-started. Movement in the left leg was then recovered. On the 1st postoperative day, the epidural catheter was removed, but weakness of both legs gradually developed. Urinary and bowel dysfunction were also found. Magnetic Resonance Imaging revealed severe lumbar spinal canal stenosis and a hematoma-like lesion. An emergent lumbar laminectomy was performed, during which no hematoma, but fluid and edematous fat, were found in the epidural space.
Elderly patients, with possible spinal canal stenosis, may have a potential risk for developing neurologic complications due to epidural anesthesia. Thus, a careful preoperative interview and thorough post-anesthesia neurological examinations are mandatory in aged subjects undergoing epidural anesthesia and analgesia.
