Abstract
Purpose
We report a case of a patient who developed a postoperative anterior spinal artery syndrome that was masked by the use of epidural analgesia. We wish to alert other anaesthetists that the use of epidural anaesthesia in this setting may mask the symptoms and delay the diagnosis of this rare complication.
Clinical features
The patient was a 22-yr-old obese man with metastatic testicular carcinoma who underwent a left-sided thoracoabdominal retropentoneal tumour resection. A lumbar epidural catheter was placed preoperatively for pain management. Postoperatively, the patient developed bilateral lower extremity weakness, which was at first attributed to epidural administration of local anaesthetics. Despite discontinuation of the local anaesthetics, the symptoms persisted. Further work-up led to the diagnosis of anterior spinal artery syndrome. The patient was sent to a rehabilitation hospital and had a partial recovery.
Conclusion
Antenor spinal artery syndrome can occur following retropentoneal surgery. It is important to recognize the potential for this complication when postoperative epidural analgesia is contemplated, especially following a left-sided surgical dissection. The use of epidural local anaesthetics iminediately after surgery delays the diagnosis of a postoperative neurological deficit. Moreover, when the deficit is recognized the epidural itself may be falsely blamed for postoperative paraplegia. If epidural analgesia is used, opioids may be preferred over local anaesthetics in the iminediate postoperative period to prevent masking of an antenor spinal artery syndrome.
Résumé
Objectif
Rapporter un cas de syndrome de l’artère spinale anténeure masqué par une anesthésie épidurale dans le but de prévenir les anesthésistes que, dans ces conditions, l’anesthésie épidurale peut dissimuler les symptômes de cette complication exceptionnelle et en retarder le diagnostic.
Éléments cliniques
Un patient obèse âgé de 22 ans atteint d’un carcinome testiculaire métastatique a subi une résection thoracoabdominale de tumeur rétropéntonéale. Un cathéter lombaire épidural avait été inséré avant l’intervention pour le traitement de la douleur. En postopératoire, le patient a présenté une faiblesse bilatérale des membres inféneurs qui fut d’abord attnbuée à l’administration épidurale de l’anesthésique local. Malgré l’interruption de l’anesthésie régionale, les symptômes ont persisté. Un bilan ultérieur a conduit au diagnostic de syndrome de l’artère spinale anténeure. Une récupération partielle a suivi son hospitalisation dans un centre de réhabilitation.
Conclusion
Le syndrome de l’artère spinale antérieure peut survenir après une chirurgie rétropéntonéale. II est important de reconnaître l’éventualité de cette complication si on considère administrer une anesthésie épidurale, surtout après une dissection du côté gauche du corps. L’administration épidurale d’un anesthésique local immédiatement après la chirurgie retarde le diagnostic d’un déficit neurologique postopératoire. En outre, même si on parvient à diagnostiquer un déficit, l’épidurale peut être blâmée à tort pour la paraplégie postopératoire. Si l’analgésie épidurale est choisie, il est préférable d’utiliser un morphinique plutôt qu’un anesthésique local à la pénode postopératoire iminédiate pour éviter que le syndrome de l’artère spinale anténeure ne passe inaperçu dans l’iminédiat.
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Linz, S.M., Charbonnet, C., Mikhail, M.S. et al. Spinal artery syndrome masked by postoperative epidural analgesia. Can J Anesth 44, 1178–1181 (1997). https://doi.org/10.1007/BF03013341
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DOI: https://doi.org/10.1007/BF03013341