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Postoperative paraplegia associated with epidural narcotic administration

Abstract

Epidural injections of buprenorphine were given for postoperative pain relief to a patient with pulmonary carcinoma who underwent a right upper lobectomy. Paraplegia occurred postoperatively and the patient’s neurological status deteriorated after each injection of epidural narcotic. Laminectomies on the third postoperative day revealed an expanded oxidized cellulose (Oxycel) pledget in the epidural space. Neurologic dysfunction after epidural narcotic administration was caused by the oxidized cellulose which had migrated into the epidural space following use for surgical haemostasis and subsequently expanded with the narcotic solution and blood.

Résumé

Les injections épidurales de buprénorphine étaient faites en période post-opératoire pour le soulagement de la douleur chez un patient atteint de carcinome pulmonaire ayant subi une lobectomie. Une paraplégie est survenue en période post-opératoire et ľétat neurologique du patient s’est détérioré après chaque injection épidurale de narcotique. Au troisième jour post-opératoire des laminectomies ont révélé la présence de tampons de cellulose oxydée et expansée (Oxycel) dans ľespace épidural. La dysfunction neurologique après chaque administration de narcotique dans ľespace épidural était provoquée par ľexpansion de la cellulose oxydée qui a migré dans ľespace épidural lors de ľhémostase chirurgicale.

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Author information

Correspondence to Chikara Tashiro or Motoki Iwasaki or Kazuya Nakahara or Ikuto Yoshiya.

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Tashiro, C., Iwasaki, M., Nakahara, K. et al. Postoperative paraplegia associated with epidural narcotic administration. Can J Anesth 34, 190 (1987). https://doi.org/10.1007/BF03015345

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Key words

  • analgesia
  • epidural
  • complications
  • paraplegia
  • oxidized cellulose
  • analgesics
  • buprenorphine