Paraplegia after thoracotomy - not caused by the epidural catheter

Background: Paraplegia and peripheral nerve injuries may arise after genera l anaesthesia from many causes but are easily ascribed to central block if the latter has been used. Case report: A 56-yr-old woman, with Bechterev disease but otherwise health y, was operated with left-sided thoracotomy to remove a tumour in the left lower lobe. She had an epidural catheter inserted in the mid-thoracic area before general anaesthesia was started. Bupivacaine 0.5% 5 ml was injected once and the infusion of bupivacaine 0.1% with 2 mu g/ml fentanyl and 2 mu g/ml adrenaline (5 ml/h) started at the end of surgery. The patient woke up with total paralysis in the lower limb and sensory analgesia at the level of Ts, which remained unchanged at several observations. Laminectomy, perfo rmed 17 h after the primary operation, showed a large piece of a haemostati c sponge (Surgicel) compressing the spinal cord, which was then decompresse d but the motor and sensory deficit remained virtually unchanged both then and a year later Conclusions: This case shows - once again - that although central blocks ma y cause serious neurological complications and paraplegia, other causes are possible and have to be considered. However, all patients with an epidural catheter must be monitored for early signs and symptoms of an intraspinal process and the appropriate treatment has to be instituted instantly.