Monoplegia after Combined Spinal Epidural Anesthesia

Serious neurological complications like permanent neurological injury after neuraxial blocks are rare in contemporary anesthetic practice. We report a case of 36 years old female undergoing venous stripping operation under combined spinal epidural anesthesia (CSE). CSE procedure was completed after second attempt at L4-L5 level and surgery was completed uneventfully. After full recovery of motor block in the recovery room patient was discharged to surgical ward. Epidural patient controlled analgesia with levobupivacine 0.125% and fentanyl 2µg/ml was started. 10 hours after surgery right lower limb sensory loss and monoplegia occurred. Epidural catheter was removed and normal MRI findings were noted. After one month physical therapy treatment and two months follow up the patient was able to walk with the aid of a walking stick. We discuss the factors that might have contributed to radiculopathy and neurotoxicity as a cause of neurologic deficit.