Anesthesiology Expert Comments on Paralysis Following Epidural Administration

Case Overview

This case involves a female patient who experienced paralysis after she was given an epidural for pain management after undergoing surgery. Before the epidural was administered, the patient underwent a surgery to remove a section of her colon as a treatment for Crohn’s disease. After the surgery was completed, she had an epidural which was placed pre-operatively by the anesthesiologist for the purpose of administering a pain block. In addition to the epidural, it was also noted that the patient had received anti-coagulation medication. The patient did not complain of any abnormal symptoms until several hours after the surgery was completed, at which point she told her nurses that she was experiencing decreased sensation and mobility in her legs. The epidural was stopped, however the numbness persisted. Eventually, doctors discovered the presence of a hematoma on the lower portion of the patient’s spine. Doctors performed emergency surgery to relieve pressure on the patient’s spinal cord, however the patient never regained the use of her legs. It is alleged that the negligent placement of the epidural, combined with the anti-coagulation treatment that the patient was given, directly contributed to her paralysis.

Questions to the Anesthesiology expert and their responses

Do you routinely perform epidural for post operative pain management?

I perform epidural analgesia for postoperative analgesia, on the order of several every month.

On a patient with an epidural, are there restrictions on anti-coagulation?

There are restrictions on anti-coagulation and epidural anesthesia, but the American Society of Regional Anesthesia does not consider the amount/type of anti-coagulant given here to be a contraindication to epidural analgesia. Most authorities recommend waiting 8 hours after the last dose is administered before placing an epidural catheter, and two hours after a dose before removing the catheter. The guidelines say that 8 hours is preferred, but they refuse to make this a standard because of the scant data to suggest an increased risk of epidural hematoma in patients receiving anti-coagulant medication.

About the expert

This highly qualified board certified expert received his undergraduate education at the highly regarded Johns Hopkins University. He subsequently received his medical degree from Hahnemann University School of Medicine where he also completed a residency in Anesthesiology. This expert is a member of numerous professional organizations including the American Society of Anesthesiologists and the Pennsylvania Society of Anesthesiologists. He is the former President of the Philadelphia Society of Anesthesiologists where he remains an active member. He has won numerous honors throughout his career most notably the Edward L. Axelman Memorial Achievement Award. This expert has published two peer-reviewed journal articles and authored four book chapters. He is currently an Associate Professor of Anesthesiology and Surgery at a major Pennsylvania based medical school.

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Specialties:

Anesthesiology