Reactions 1366 - 27 Aug 2011

SBupivacaine/ropivacaine

Cauda equina syndrome following spinal-epiduralanaesthesia: case report

A 79-year-old man with Paget’s disease of skindeveloped cauda equina syndrome following intrathecalbupivacaine and epidural ropivacaine for spinalanaesthesia.

The man had a history of bronchiectasis andtuberculosis. He was scheduled for removal of a skintumour below his scrotum. He received 3mL of hyperbaricbupivacaine 0.5% into the L3-4 interspace; 90 minuteslater, he received a 5mL bolus of ropivacaine 0.5%,followed by an infusion of ropivacaine 0.15% at 4 mL/h andinstitution of patient-controlled epidural analgesia. Heexperienced urinary retention when his urinary catheterwas removed on postoperative day 5, and the catheter wasreinserted. A diagnosis of neurogenic bladder was made2 days later. Hypoesthesia at the perianal area in the S4-5segment was observed the next day. He had no significantanal sphincter function, fecal incontinence and numbnesson the soles of both feet. Postoperative day 13, he wasdiagnosed with cauda equina syndrome, thought to be dueto anaesthetic-induced neurotoxicity. His urinary retention,fecal incontinence and perianal hypoesthesia persisteduntil discharge on postoperative day 21. Perianalhypoesthesia had resolved completely 4 months aftersurgery and complete recovery from urinary retention andfecal incontinence was shown 6 months later.

Author comment: "[B]ased on the patient’s symptoms andMRI findings, the etiology of cauda equina syndrome wasbelieved to be toxicity of bupivacaine alone or incombination with ropivacaine."Kato J, et al. Cauda equina syndrome following combined spinal and epiduralanesthesia: A case report. Canadian Journal of Anesthesia 58: 638-641, No. 7, Jul2011. Available from: URL: http://dx.doi.org/10.1007/s12630-011-9505-7 -Japan 803059403

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Reactions 27 Aug 2011 No. 13660114-9954/10/1366-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved