Perioperative stroke associated with postoperative epidural analgesia

• Published in: Journal of clinical anesthesia Vol. 12; no. 1; pp. 61 - 63
• Main Authors: Wu, Christopher L, Francisco, David R, Benesch, Curtis G
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2000; Elsevier Science
• Subjects: Aged; Analgesia; Analgesia, Epidural - adverse effects; Analgesics, Opioid - therapeutic use; Anesthesia; Anesthesia, Epidural; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - adverse effects; Arm - innervation; Biological and medical sciences; Cerebral Infarction - etiology; Chondrosarcoma - surgery; epidural; Femoral Neoplasms - surgery; Humans; hypotension; Hypotension - etiology; Leg - innervation; Lidocaine - adverse effects; Local anesthesia. Pain (treatment); Male; Medical sciences; Morphine - therapeutic use; Movement Disorders - etiology; Postoperative Complications; Sensation Disorders - etiology; stroke; Stroke - etiology; watershed infarction; hypotension; Analgesia; epidural; watershed infarction; stroke; Human; Postoperative; Nervous system diseases; Stroke; Toxicity; Cardiovascular disease; Cerebral disorder; Vascular disease; Local anesthetic; Case study; Chemotherapy; Pain; Treatment; Ischemia; Arterial hypotension; Extradural administration; Central nervous system disease; Complication; Organic amide; Lidocaine; Cerebrovascular disease; Brain (vertebrata)
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/S0952-8180(99)00128-2

A patient with an epidural catheter for postoperative analgesia developed a stroke in association with a hypotensive episode resulting from a bolus of local anesthetic. After undergoing resection for femoral chondrosacroma under epidural anesthesia, the patient received a continuous infusion of epidural morphine for postoperative analgesia. Lidocaine 1% (10 mL in divided doses) was administered through the catheter for breakthrough pain. The patient experienced a hypotensive episode and was noted to have a motor and cortical sensory deficit of the left arm and leg 8 hours after the hypotensive episode. Clinical presentation and subsequent workup were consistent with a watershed infarction. The patient recovered full neurologic function before discharge. Postoperative hypotension from epidural analgesia may be associated with stroke; however, a cause-and-effect relationship usually cannot be established with certainty.