L Kahn1. 1. Department of Anesthesia, St. Joseph's Hospital, Hamilton, Ontario, Canada. kahnl@fhs.mcmaster.ca
Abstract
PURPOSE: The purpose of this report is to emphasise the role of the Acute Pain Service in managing local anaesthetic epidural infusions for postoperative pain management, the importance of vigilant monitoring, and to offer some guidelines to using local anaesthetic epidural infusions. CLINICAL FEATURES: A 34-yr-old man with long-standing insulin dependent diabetes mellitus underwent a total proctocolectomy for inflammatory bowel disease. A T9-10 epidural catheter was placed prior to induction of general anaesthesia. Postoperatively, a continuous epidural infusion of fentanyl/bupivacaine was used for postoperative pain management. Total lithotomy time was four hours. On day four he was noted to have complete right sided femoral and left sided lateral femoral cutaneous nerve of thigh neuropathies. A computerised tomography scan and a magnetic resonance imaging excluded a central lesion. Electromyelography confirmed peripheral nerve injuries. CONCLUSION: This patient's neurological deficits were not due to the epidural analgesia. However, epidural infusion of local anaesthetic caused a delay in recognising a potential neurological complication. When using local anaesthetic epidural infusions, it is important to exclude other causes of motor block before attributing it to the local anaesthetic.
PURPOSE: The purpose of this report is to emphasise the role of the Acute Pain Service in managing local anaesthetic epidural infusions for postoperative pain management, the importance of vigilant monitoring, and to offer some guidelines to using local anaesthetic epidural infusions. CLINICAL FEATURES: A 34-yr-old man with long-standing insulin dependent diabetes mellitus underwent a total proctocolectomy for inflammatory bowel disease. A T9-10 epidural catheter was placed prior to induction of general anaesthesia. Postoperatively, a continuous epidural infusion of fentanyl/bupivacaine was used for postoperative pain management. Total lithotomy time was four hours. On day four he was noted to have complete right sided femoral and left sided lateral femoral cutaneous nerve of thigh neuropathies. A computerised tomography scan and a magnetic resonance imaging excluded a central lesion. Electromyelography confirmed peripheral nerve injuries. CONCLUSION: This patient's neurological deficits were not due to the epidural analgesia. However, epidural infusion of local anaesthetic caused a delay in recognising a potential neurological complication. When using local anaesthetic epidural infusions, it is important to exclude other causes of motor block before attributing it to the local anaesthetic.