Sudden transient paraplegia shortly after preoperative thoracic epidural catheterization-A case report

We report a case of sudden onset of paraplegia shortly after thoracic epidural catheterization for postoperative analgesia and discuss the possible causes of this event. A 38-year-old woman was scheduled to receive right lobectomy of liver because of hepatocellular carcinoma. Thoracic epidural catheterization for postoperative analgesia was performed before the induction of anesthesia. After skin disinfection and local anesthetic skin infiltration with lidocaine, epidural catheterization through T_10-11 interspace was performed. Dural puncture without any neurological symptoms was noticed in the attempt and the epidural space was successfully identified through T _9-10 interspace in the second attempt. However, acute motor weakness and sensory impairment were met as the epidural catheter was being threaded into the epidural space. Magnetic resonance imaging (MRI) revealed no abnormal findings and the neurological deficits resolved spontaneously within 2 h without any sequela. Finally, it was supposed that the transient neurological deficits were resultant from accidental subarachnoid injection of the local anesthetics used for skin infiltration. Preoperative image studies of the spine revealed a relatively short skin-to-dura distance either from median or paramedian approach, which might be the cause of the inadvertent intrathecal injection of local anesthetic during skin infiltration.