Journal of Anesthesia

, 23:601 | Cite as

Transient lower limb pain following accidental thoracic subarachnoid insertion of an epidural catheter

  • Masaki Fuyuta
  • Yoshihiro Takasugi
  • Masahiro Morimoto
  • Toru Shirai
  • Mitsuo Morimoto
  • Yoshihisa Koga
Clinical Report


Transient sensory disturbances, including dysesthesia or neurologic deficits in the lower extremities or buttocks have been described as complications of neuraxial anesthesia. We report a case of transient lower limb pain following the accidental placement of an epidural catheter into the thoracic subarachnoid space. A 31-year-old woman was scheduled to undergo laparoscopic myomectomy. An epidural catheter was accidentally inserted subarachnoid at the T12–L1 intervertebral space with a 2-ml test dose of 2% lidocaine, and was promptly removed. Fulgurant pain and allodynia extending over the L2–5 areas of the left lower limb and buttock started immediately postoperatively. We treated the persistent pain in our patient with epidural infusion of local anesthetics and steroids during her hospital stay, and with carbamazepine and a tricyclic antidepressant after her discharge from the hospital. All signs of allodynia had disappeared on postoperative day 25. Sagittal and axial T2-weighted magnetic resonance imaging (MRI) at the Th12 level revealed a small high-intensity area without mass effect in the ipsilateral dorsal column. The patient’s clinical course and MRI diagnosis suggested the inhibition of descending inhibitory pathways resulting from a lesion of the spinal cord as the possible etiology of the transient lower limb pain and allodynia.

Key words

Transient lower limb pain Descending inhibitory pathways Spinal cord lesions 


  1. 1.
    Pollock JE. Transient neurologic symptoms: etiology, risk factors, and management. Reg Anesth Pain Med. 2002;27:581–586.PubMedGoogle Scholar
  2. 2.
    Freedman JM, Li DK, Drasner K, Jaskela MC, Larsen B, Wi S. Transient neurologic symptoms after spinal anesthesia: an epidemiologic study of 1863 patients. Anesthesiology. 1998;89:633–641.CrossRefPubMedGoogle Scholar
  3. 3.
    Hodgson PS, Neal JM, Pollock JE, Liu SS. The neurotoxicity of drugs given intrathecally (spinal). Anesth Analg. 1999;88:797–809.CrossRefPubMedGoogle Scholar
  4. 4.
    Yamashita A, Matsumoto M, Matsumoto S, Itoh M, Kawai K, Sakabe T. A comparison of the neurotoxic effects on the spinal cord of tetracaine, lidocaine, bupivacaine, and ropivacaine administered intrathecally in rabbits. Anesth Analg. 2003;97:512–519.CrossRefPubMedGoogle Scholar
  5. 5.
    Sakura S, Kirihara Y, Muguruma T, Kishimoto T, Saito Y. The comparative neurotoxicity of intrathecal lidocaine and bupivacaine in rats. Anesth Analg. 2005;101:541–547.CrossRefPubMedGoogle Scholar
  6. 6.
    Takenami T, Yagishita S, Murase S, Hiruma H, Kawakami T, Hoka S. Neurotoxicity of intrathecally administered bupivacaine involves the posterior roots/posterior white matter and is milder than lidocaine in rats. Reg Anesth Pain Med. 2005;30:464–472.PubMedGoogle Scholar
  7. 7.
    Zaric D, Christiansen C, Pace NL, Punjasawadwong Y. Transient neurologic symptoms after spinal anesthesia with lidocaine versus other local anesthetics: a systematic review of randomized, controlled trials. Anesth Analg. 2005;100:1811–1816.CrossRefPubMedGoogle Scholar
  8. 8.
    Kelly AM. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J. 2001;18:205–207.CrossRefPubMedGoogle Scholar
  9. 9.
    Kasai T, Yaegashi K, Hirose M, Tanaka Y. Spinal cord injury in a child caused by an accidental dural puncture with a single-shot thoracic epidural needle. Anesth Analg. 2003;96:65–67.CrossRefPubMedGoogle Scholar
  10. 10.
    Mayall MF, Calder I. Spinal cord injury following an attempted thoracic epidural. Anaesthesia. 1999;54:990–994.CrossRefPubMedGoogle Scholar
  11. 11.
    Pubols LM, Simone DA, Bernau NA, Atkinson JD. Anesthetic blockade of the dorsolateral funiculus enhances evoked activity of spinal cord dorsal horn neurons. J Neurophysiol. 1991;66:140–152.PubMedGoogle Scholar
  12. 12.
    Sandkühler J, Fu QG, Zimmermann M. Spinal pathways mediating tonic or stimulation-produced descending inhibition from the periaqueductal gray or nucleus raphe magnus are separate in the cat. J Neurophysiol. 1987;58:327–341.PubMedGoogle Scholar
  13. 13.
    Tong D, Wong J, Chung F, Friedlander M, Bremang J, Mezei G, Streiner D. Prospective study on incidence and functional impact of transient neurologic symptoms associated with 1% versus 5% hyperbaric lidocaine in short urologic procedures. Anesthesiology. 2003;98:485–494.CrossRefPubMedGoogle Scholar
  14. 14.
    Evron S, Gurstieva V, Ezri T, Gladkov V, Shopin S, Herman A, Sidi A, Weitzman S. Transient neurological symptoms after isobaric subarachnoid anesthesia with 2% lidocaine: the impact of needle type. Anesth Analg. 2007;105:1494–1499.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2009

Authors and Affiliations

  • Masaki Fuyuta
    • 1
  • Yoshihiro Takasugi
    • 1
  • Masahiro Morimoto
    • 1
  • Toru Shirai
    • 1
  • Mitsuo Morimoto
    • 1
  • Yoshihisa Koga
    • 1
  1. 1.Department of AnesthesiologyKinki University School of MedicineOsakaJapan

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