ABSTRACT
Cauda equina syndrome after epidural block is a rare complication, but it requires emergency surgery when it is diagnosed. A 65-year-old man who underwent epidural block at a local clinic was admitted with right lower leg weakness and decreased leg sensation, severe lower radiating pain, dysuria and decreasing sensation in the perianal region. Magnetic resonance image showed protruded disc material between L4-L5 and a hematoma that occupied most of the spinal canal and this was compressing the spinal cord. These findings were diagnostic for cauda equina syndrome after epidural block and so laminectomy, excision of the herniated disc and removal of the hematoma were done. At 6 months follow-up, the neurologic symptoms were resolved except for the dorsiflextion of the ankle and the big toe. We report here on a case of cauda equina syndrome as a rare complication after epidural anesthesia.
Subject(s)
Aged , Animals , Humans , Anesthesia, Epidural , Ankle , Cauda Equina , Dysuria , Emergencies , Follow-Up Studies , Hematoma , Intervertebral Disc Displacement , Laminectomy , Leg , Magnetic Resonance Spectroscopy , Neurologic Manifestations , Polyradiculopathy , Sensation , Spinal Canal , Spinal Cord , ToesABSTRACT
BACKGROUND: Lumbar epidural block is now a popular technique for anesthesia and post operative analgesia. It may be helpful for prevention of complication during this procedure to know the depth from the skin to the lumbar epidural space before the procedure. This study was undertaken to evaluate the depth from the skin to the lumbar epidural space and to determine any potential relationship between a patient's data (age, weight, and height) and the measured depth in Korean children. METHODS: We investigated the electronic records of 662 Korean children who were received urologic surgeries with epidural catheterization for postoperative analgesia. The patients' gender, age, weight, height and epidural depth were recorded and analyzed with multiple linear regression test using SPSS 13.0 (SPSS Co., Ilinois, USA). RESULTS: The patient's age and weight were significantly correlated to the skin-epidural space depth in Korean children. Body weight was more significant variable than age on the epidural depth. The empirical formula derived from the results was as follow; epidural depth (mm) = 9 + 0.5 x body weight (kg) - 0.2 x age (months). CONCLUSIONS: We suggest that the depth of skin-lumbar epidural space can be estimated with the empirical formula based on body weight and age.