Sudden motor and sensorial loss due to retroperitoneal hematoma during postoperative periods: a case report

Pelin Ş; en; Havva Gül Gültekin; İ; smail Caymaz; Ömer Özel; Ayda Türköz

doi:10.1016/j.bjane.2016.02.006

Clinical Informations

Sudden motor and sensorial loss due to retroperitoneal hematoma during postoperative periods: a case report

Súbita perda sensitiva e motora devido a hematoma retroperitoneal durante os períodos de pós-operatório: relato de caso

Pelin Ş; en; Havva Gül Gültekin; İ; smail Caymaz; Ömer Özel; Ayda Türköz

http://dx.doi.org/10.1016/j.bjane.2016.02.006 Braz J Anesthesiol, vol.67, n5, p.548-551, 2017

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Abstract

Abstract A 68 year-old male patient was hospitalized for radical prostatectomy. He had no abnormal medical history including neurological deficit before the operation. Prior to general anesthesia, an epidural catheter was inserted in the L3-4 interspace for intraoperative and postoperative analgesia. After surgery for nine hours, he developed confusion and flaccid paralysis of bilateral lower extremities occurred. No pathology was detected from cranial computed tomography and diffusion magnetic resonance imaging no pathology was detected. His thoracic/lumbar magnetic resonance imaging. Intraabdominal pressure was shown to be 25 mmHg, and abdominal ultrasonography revealed progression in the inflammation/edema/hematoma in the perirenal region. The Bromage score was back to 1 in the right foot on the 24th hour and in the left foot on the 26th hour. Paraplegia developed in patients after epidural infusion might be caused by potentiated local anesthetic effect due to retroperitoneal hematoma and/or elevated intra-abdominal pressure.

Keywords

Epidural anesthesia, Flaccid paralysis, Retroperitoneal hematoma

Resumo

Resumo Paciente do sexo masculino, 68 anos, hospitalizado para prostatectomia radical. O paciente não tinha história médica anormal, inclusive nem déficit neurológico, antes da operação. Antes da anestesia geral, um cateter peridural foi inserido no espaço intermédio L3-4 para analgesia no intra e pós-operatório. Após a cirurgia, que durou nove horas, o paciente desenvolveu confusão e paralisia flácida bilateral dos membros inferiores. Tomografia computadorizada de crânio e imagem de difusão por ressonância magnética não detectaram lesão. Os achados nas imagens de ressonância magnética torácica/lombar eram normais. A pressão intra-abdominal era de 25 mmHg e o ultrassom abdominal revelou progressão de inflamação/edema/hematoma na região perirrenal. O escore de Bromage voltou a 1 no pé direito na 24a hora e no pé esquerdo na 26a hora. A paraplegia desenvolvida nos pacientes após a infusão epidural pode ter sido causada por um efeito potencializado do anestésico local devido a hematoma retroperitoneal e/ou pressão intra-abdominal elevada.

Palavras-chave

Anestesia peridural, Paralisia flácida, Hematoma retroperitonial

References

Ortiz de la Tabla González R, Martínez Navas A. Neurologic complications of central neuraxial blocks. Rev Esp Anestesiol Reanim. 2011;58:434-43.

Reynolds F. Damage to the conus medullaris following spinal anaesthesia. Anaesthesia. 2001;56:238-47.

Auroy Y, Narchi P, Messiah A. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology. 1997;87:479-86.

Myers RR, Heckman HM. Effects of local anesthesia on nerve blood flow: studies using lidocaine with and without epinephrine. Anesthesiology. 1989;71:757-62.

Rigler ML, Drasner K, Krejcie TC. Cauda equina syndrome after continuous spinal anesthesia. Anesth Analg. 1991;72:275-81.

Tryba M. Epidural regional anesthesia and low molecular heparin: Pro. Anasthesiol Intensivmed Notfallmed Schmerzther. 1993;28:179-81.

de Medicis E, de Leon-Casasola OA. Reversible paraplegia associated with lumbar epidural analgesia and thoracic vertebral metastasis. Anesth Analg. 2001;92:1316-8.

Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuraxial blockades in Sweden 1990-1999. Anesthesiology. 2004;101:950-9.

Mayall MF, Calder I. Spinal cord injury following an attempted thoracic epidural. Anaesthesia. 1999;54:990-4.

Short HD. Paraplegia associated with the use of oxidized cellulose in posterolateral thoracotomy incisions. Ann Thorac Surg. 1990;50:288-9.

Mato M, Perez A, Otero J. Paraplegia after left thoracotomy in a patient carrying an epidural catheter. Rev Esp Anestesiol Reanim. 2001;48:89-92.

Hirlekar G. Paraplegia after epidural analgesia associated with an extradural spinal tumor. Anaesthesia. 1980;35:363-4.

Matsuura JA, Makhoul RG, Posner MP. Intradural herniation of a thoracic disc causing paraplegia coincident with epidural anesthesia. Anesth Analg. 1997;84:922-3.

Crystal Z, Katz Y. Postoperative epidural analgesia and possible transient anterior spinal artery syndrome. Pain Practice. 2001;1:372-3.

Redai İ. The anesthesia guide. Physiology of pregnancy. 2013:757-86.

Sudden motor and sensorial loss due to retroperitoneal hematoma during postoperative periods: a case report

Súbita perda sensitiva e motora devido a hematoma retroperitoneal durante os períodos de pós-operatório: relato de caso

Pelin Ş; en; Havva Gül Gültekin; İ; smail Caymaz; Ömer Özel; Ayda Türköz

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