CAUDA-EQUINA SYNDROME AFTER SPINAL-ANESTHESIA IN A PATIENT WITH SEVERE VASCULAR-DISEASE

purpose: Spinal anaesthesia is selected for many lower extremity surgi cal procedures each year in the United States with a high degree of sa fety and efficacy. Even when adverse neurological outcomes have occurr ed, anatomical abnormality or coagulopathy have been implicated in the majority of cases. Epinephrine is used in high concentrations in many of these anaesthetics to increase the duration and intensity of the b lock. Although epinephrine is known to decrease spinal cord blood flow , its use in normal patients has not caused complications. We report a case where spinal anaesthesia with bupivacaine and epinephrine result ed in anterior spinal artery compromise and the development of a cauda equina syndrome postoperatively. Clinical Features: A 57-yr-old man w ith severe coronary artery and peripheral vascular disease was schedul ed for incision and drain of an abscess of the left thigh. He received an atraumatic dural puncture and injection of 12.5 mg bupivacaine wit h 0.2 ml 1:1000 epinephrine. During onset, he experienced a severe, pa inful sensation of the thighs which resolved with development of the b lock . Postoperatively, he was noted to have exacerbation of proximal muscle weakness and decreased perineal sensation and rectal tone. Subs equent EMG studies demonstrated proximal neuron loss consistent with c auda equina syndrome, presumed to be related to insufficient of the an terior spinal artery. Conclusion: Routine use of epinephrine in spinal anaesthesia for patients with multi-organ vascular disease should be considered carefully because of the possibility of vascular insufficie ncy of the spinal cord which would be exaggerated by the vasoconstrict ive effect of epinephrine.