Incomplete sensorimotor paresis after upper abdominal surgery with TEA and spinal epidural lipomatosis: a case report.

Autor:	Zugaj MR; Heidelberg University, Medical Faculty, Department of Anesthesiology, Heidelberg, Baden-Württemberg, Germany marco.zugaj@med.uni-heidelberg.de., Gutzeit O; Heidelberg University, Medical Faculty, Department of Anesthesiology, Heidelberg, Baden-Württemberg, Germany., Mayer VL; Heidelberg University, Medical Faculty, Department of Nuclear Medicine, Heidelberg, Baden-Württemberg, Germany., Ishak B; Heidelberg University, Medical Faculty, Department of Neurosurgery, Heidelberg, Baden-Württemberg, Germany., Gumbinger C; Heidelberg University, Medical Faculty, Department of Neurology, Heidelberg, Baden-Württemberg, Germany., Weigand MA; Heidelberg University, Medical Faculty, Department of Anesthesiology, Heidelberg, Baden-Württemberg, Germany., Keßler J; Heidelberg University, Medical Faculty, Department of Anesthesiology, Heidelberg, Baden-Württemberg, Germany.
Jazyk:	angličtina
Zdroj:	Regional anesthesia and pain medicine [Reg Anesth Pain Med] 2024 Jun 03; Vol. 49 (6), pp. 465-468. Date of Electronic Publication: 2024 Jun 03.
DOI:	10.1136/rapm-2024-105342
Abstrakt:	Introduction: This case report documents a postoperative, incomplete sensorimotor paraparesis from thoracic vertebral body 6 (Th6) after combined anesthesia for upper abdominal surgery in a patient who had a thoracic localization of spinal epidural lipomatosis (SEL). Case Presentation: The patient was treated in our clinic with a thoracic epidural catheter (TEA) for perioperative analgesia during a partial duodenopancreatectomy. Paraparetic symptoms occurred 20 hours after surgery. Initial MRI did not show bleeding, infection or spinal cord damage and the neurosurgeon consultants recommended observation. The neurological examination and the third follow-up MRI on 15th postoperative day showed ventrolateral damage of the spinal cord at level Th6. It is possible that local anesthetic compressed the spinal cord in addition to the existing lipomatosis and the thoracic kyphosis. The paraparesis improved during follow-up paraplegiologic treatment. Conclusion: So far, only two uncomplicated lumbar epidural catheter anesthesias have been described in patients who had a lumbar SEL. Epidural catheter anesthesia is a safe and effective method of pain control. But it is important to carefully identify and stratify patients with risk factors during the premedication visit. In patients who had kyphosis and thoracic localization of SEL, TEA may only be used after a risk-benefit assessment. Competing Interests: Competing interests: MAW: Grants or contracts were received from Köhler Chemie, DFG and DZIF. Consulting fees was received from MSD, Gilead, Shionogi, B. Braun, Biotest, Pfizer, Eumedica, SOBI, Mundipharma and Böhringer Ingelheim. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events was received from MSD, Gilead, Pfizer, Shionogi and Mundipharma. Patents planned, issued or pending include EP17185036.5 and EP17198330.7. There are leadership or fiduciary roles in the German Sepsis Society as secretary general and on the board of PEG. Other financial or non-financial interests include being a cofounder of Delta Diagnostics. The other authors declare no conflicts of interest related to the content of the manuscript. (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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