Neurological impairment following myocardial ischemia associated with postoperative epidural analgesia

Chia Chih Liao, Yuan Ji Day, Min Wen Yang, Ta Sen Lin*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review


Although epidural analgesia reduces the postoperative stress response and provides good pain relief for patients, potential complications associated with the technique may decrease its acceptability for some patients. We describe a 76-year-old female who underwent surgery for carcinoma of the urinary tract. Postoperative epidural analgesia was performed at the postanesthesia care unit. Neither a repeat attempt nor accidental dural puncture was encountered during the procedure. Unfortunately, she sustained neurological impairment of the bilateral lower limbs following an episode of myocardial ischemia during the early postoperative period. When the neurological deficit was recognized following epidural anesthesia, poor puncture technique was the first to be blamed. In fact, a high level of sensory blockade could markedly decrease blood pressure and heart rate, particularly in the presence of hypovolemia, which might lead to impairment of coronary perfusion and result in myocardial ischemia. Severe systemic hypotension might further lead to hypoperfusion of the spinal cord, most possibly in the mid-thoracic region (T4 to T8) due largely to its relative hypovascularity. Therefore, we recommend that maintaining sufficient circulatory volume of the patient, evaluating and recording the neurological function of the patient and determining the possible risk factors associated with coronary arterial disease are imperative prior to performing an epidural procedure.

Original languageEnglish
Pages (from-to)194-198
Number of pages5
JournalActa Anaesthesiologica Taiwanica
Issue number4
StatePublished - 12 2008
Externally publishedYes


  • Analgesia
  • Epidural
  • Myocardial ischemia
  • Neurologic manifestations


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