Slowly progressive paraplegia caused by metastatic epidural tumor during epidural analgesia for postoperative pain treatment: a case report
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We report a patient having unrecognized epidural metastasis from prostate cancer who developed a slowly progressive paraplegia during epidural analgesia for postoperative pain treatment. A 69-year-old man was scheduled for laparoscopic cholecystectomy. After an epidural catheter was inserted through T10-11 intervertebral space, anesthesia was maintained with general anesthesia combined with epidural anesthesia. Bupivacaine of 0.25% was infused postoperatively at a rate of 2ml/h through the epidural catheter. On postoperative day (POD) 1, the patient complained of numbness in the left lower limb. Epidural infusion of bupivacaine was withheld and the epidural catheter was removed. On POD 3, he noted mild decrease of muscle strength in both lower limbs. On POD 5, slowly progressive paraplegia below T9 with total sensory loss except for warm sensation developed. Magnetic resonance imaging (MRI) revealed multiple bone metastases in the thoracic vertebrae, and fat-suppressed T2-weighted MRI showed that an epidural mass compressed the spinal cord at T8 level. Emergency laminectomy and spinal fixation were performed six hours after the onset of paraplegia. Pathologic examination showed that the tumor was metastatic anaplastic adenocarcinoma from the prostate. The muscle power recovered in two weeks postoperatively. He was discharged two months after the surgery, without motor impairment of the lower limbs.
- 一般社団法人 日本ペインクリニック学会の論文
一般社団法人 日本ペインクリニック学会 | 論文
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