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Incomplete sensorimotor paresis after upper abdominal surgery with TEA and spinal epidural lipomatosis: a case report
  1. Marco Richard Zugaj1,
  2. Oliver Gutzeit1,
  3. Victoria Louise Mayer2,
  4. Basem Ishak3,
  5. Christoph Gumbinger4,
  6. Markus Alexander Weigand1 and
  7. Jens Keßler1
  1. 1Heidelberg University, Medical Faculty, Department of Anesthesiology, Heidelberg, Baden-Württemberg, Germany
  2. 2Heidelberg University, Medical Faculty, Department of Nuclear Medicine, Heidelberg, Baden-Württemberg, Germany
  3. 3Heidelberg University, Medical Faculty, Department of Neurosurgery, Heidelberg, Baden-Württemberg, Germany
  4. 4Heidelberg University, Medical Faculty, Department of Neurology, Heidelberg, Baden-Württemberg, Germany
  1. Correspondence to Dr Marco Richard Zugaj, Department of Anestesiology, Heidelberg University Medical Faculty Heidelberg, Heidelberg, Baden-Württemberg, Germany; marco.zugaj{at}med.uni-heidelberg.de

Abstract

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.

  • Acute Pain
  • Treatment Outcome
  • Postoperative Complications
  • Pain, Postoperative
  • analgesia

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Footnotes

  • Contributors MRZ: data collection and analysis and draft, revision and approval of the final manuscript. OG, VLM, CG, BI, MAW and JK: data analysis and revision of the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • 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.

  • Provenance and peer review Not commissioned; externally peer reviewed.