Journal of Clinical Anesthesia
Volume 12, Issue 1 , Pages 61-63, February 2000

Perioperative stroke associated with postoperative epidural analgesia

  • Christopher L Wu, MD (Assistant Professor of Anesthesiology)

      Affiliations

    • Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
    • Corresponding Author InformationAddress correspondence to Dr. Wu, at the The Johns Hopkins Hospital, Division of Pain Medicine, 550 No. Broadway, Suite 301, Baltimore, MD 21205, USA
    • ,
  • David R Francisco, MD (Attending Anesthesiologist)

      Affiliations

    • Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
    • ,
  • Curtis G Benesch, MD (Assistant Professor of Neurology)

      Affiliations

    • Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

Received 16 August 1999; received in revised form 5 October 1999; accepted 5 October 1999.

Abstract 

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.

Keywords:  Analgesia, epidural, hypotension, stroke, watershed infarction

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PII: S0952-8180(99)00128-2

Journal of Clinical Anesthesia
Volume 12, Issue 1 , Pages 61-63, February 2000

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