Korean J Anesthesiol.  2003 Nov;45(5):661-663. 10.4097/kjae.2003.45.5.661.

A Case on Diplopia after Epidural Catheterization for Postoperative Pain Control: A case report

• Kim YJ
• Byun TK
• Lee KM
• Jung SH
• Choe YK
• Park JW
• Shin CM
• Park JY

• KMID: 1935959
• DOI: http://doi.org/10.4097/kjae.2003.45.5.661

Abstract

A 53 year old man with gastric cancer was admitted for radical subtotal gastrectomy. The patient received general anesthesia with epidural analgesia. Epidural catheterization was performed using an 18-gauge Tuohy needle at the T10-11 interspace, and the epidural space was confirmed after a repeated attempt. An epidural catheter was then advanced smoothly 5 cm in cephalad direction without bleeding or CSF leakage. The patient received a test dose of lidocaine and epinephrine and continuous infusion with morphine and lidocaine 30 minutes before operation finished. Vital signs during the operation were stable. Two days after the operation, the patient complained of an orthostatic headache, and relieved ketolorac. On the seventh day, the patient complained of bilateral diplopia. Diffuse pachymeningeal gadolonium enhancement was seen on the brain MRI, and his CSF pressure was 0 mmHg by spinal tapping. We suspected abducent nerve palsy due to CSF hypovolemia and performed an epidural blood patch with 15 ml of autologus blood at the previous puncture site. The patient is receiving regular examinations at the Neurology and Opthalmology department. Abducent nerve palsy completely recovered by the Hess Screen test 6 months after operation, and diplopia disappeared 10 months after the operation.

Keyword

abducent nerve palsy; CSF hypovolemia; diplopia; epidural analgesia

MeSH Terms

Abducens Nerve
Analgesia, Epidural
Anesthesia, General
Blood Patch, Epidural
Brain
Catheterization*
Catheters*
Diplopia*
Epidural Space
Epinephrine
Gastrectomy
Headache
Hemorrhage
Humans
Hypovolemia
Lidocaine
Magnetic Resonance Imaging
Middle Aged
Morphine
Needles
Neurology
Pain, Postoperative*
Paralysis
Punctures
Spinal Puncture
Stomach Neoplasms
Vital Signs
Epinephrine
Lidocaine
Morphine