Monoplegia after combined spinal epidural anesthesia

Abstract

Serious neurological complications after neuraxial block, including permanent neurological injury, are rare in contemporary anesthetic practice. We report a case of a 36 year old female undergoing a venous stripping operation under combined spinal epidural anesthesia (CSE). The CSE procedure was completed after a second attempt at the L4-L5 level and the surgery was completed uneventfully. After full recovery of motor block in the recovery room, the patient was discharged to the surgical ward. Epidural patient controlled analgesia with levobupivacine 0.125% and fentanyl 2 µg/ml was initiated. 10 hours after surgery, right lower limb sensory loss and monoplegia occurred. The epidural catheter was removed and normal MRI findings were noted. After one month of physical therapy treatment and two months follow up the patient was able to walk with the aid of a walking stick. We discuss factors that might have contributed to radiculopathy and neurotoxicity as a cause of neurologic deficit.