Ischemic neuropathy presenting as prolonged epidural anesthesia.

Overview

A patient presented with a neuropathy originally ascribed to prolonged effect of epidural anesthesia following major intraabdominal surgery. Subsequent investigation revealed the cause of the neuropathy to be an arterial thrombosis. Two percent lidocaine and 0.5% bupivicaine were used intraoperatively and epidural morphine was administered at the end of the operation. The causes of prolonged neural blockade from epidural anesthesia are reviewed. Ischemia is a well known cause of neuropathy, and when ischemic pain is masked with the use of epidural narcotics, the neurologic deficit produced can be similar to that of prolonged action of epidurally administered local anesthesia. Ischemia should be included in the differential diagnosis of prolonged neurologic deficit in this situation. If examination reveals ischemia as a possible cause of neurologic deficit (e.g., asymmetrical or absent pulses), an angiogram should be obtained quickly to provide the best opportunity for rapid surgical treatment.